Estatísticas

 array:26 [
  "pii" => "S0870255116302165"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2016.06.009"
  "estado" => "S300"
  "fechaPublicacion" => "2017-01-01"
  "aid" => "889"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2017;36:9-15"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3324
    "formatos" => array:3 [
      "EPUB" => 184
      "HTML" => 2555
      "PDF" => 585
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S217420491630229X"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2017-01-01"
      "aid" => "889"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2017;36:9-15"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3263
        "formatos" => array:3 [
          "EPUB" => 177
          "HTML" => 2512
          "PDF" => 574
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "9"
            "paginaFinal" => "15"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Import&#226;ncia da deforma&#231;&#227;o longitudinal na dete&#231;&#227;o da cardiotoxicidade induzida por quimioterapia e na identifica&#231;&#227;o de padr&#245;es espec&#237;ficos de afeta&#231;&#227;o segmentar"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1035
                "Ancho" => 1500
                "Tamanyo" => 75265
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Changes in global longitudinal strain &#40;GLS&#41; between baseline and follow-up echocardiograms for the total study population&#44; showing worsening GLS during chemotherapy&#46; The central line represents mean GLS&#44; and the error bars represent the 95&#37; confidence interval for one standard deviation&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Guilherme Portugal, Lu&#237;sa Moura Branco, Ana Galrinho, Miguel Mota Carmo, Ana Teresa Tim&#243;teo, Joana Feliciano, Jo&#227;o Abreu, S&#243;nia Duarte Oliveira, Lurdes Batarda, Rui Cruz Ferreira"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "Guilherme"
                "apellidos" => "Portugal"
              ]
              1 => array:2 [
                "nombre" => "Lu&#237;sa"
                "apellidos" => "Moura Branco"
              ]
              2 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Galrinho"
              ]
              3 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "Mota Carmo"
              ]
              4 => array:2 [
                "nombre" => "Ana Teresa"
                "apellidos" => "Tim&#243;teo"
              ]
              5 => array:2 [
                "nombre" => "Joana"
                "apellidos" => "Feliciano"
              ]
              6 => array:2 [
                "nombre" => "Jo&#227;o"
                "apellidos" => "Abreu"
              ]
              7 => array:2 [
                "nombre" => "S&#243;nia"
                "apellidos" => "Duarte Oliveira"
              ]
              8 => array:2 [
                "nombre" => "Lurdes"
                "apellidos" => "Batarda"
              ]
              9 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Cruz Ferreira"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0870255116302165"
          "doi" => "10.1016/j.repc.2016.06.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302165?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491630229X?idApp=UINPBA00004E"
      "url" => "/21742049/0000003600000001/v1_201701200114/S217420491630229X/v1_201701200114/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255116302906"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.10.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "907"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2017;36:17-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3056
      "formatos" => array:3 [
        "EPUB" => 201
        "HTML" => 2349
        "PDF" => 506
      ]
    ]
    "pt" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio Editorial</span>"
      "titulo" => "Cardiotoxicidade subcl&#237;nica em oncologia&#58; o impacto da dete&#231;&#227;o precoce"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "17"
          "paginaFinal" => "19"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Subclinical cardiotoxicity in cancer therapy&#58; The impact of early detection"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana G&#46; Almeida"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Ana G&#46;"
              "apellidos" => "Almeida"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204916302306"
        "doi" => "10.1016/j.repce.2016.11.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302306?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302906?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116302906/v2_201701040047/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255116302979"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.10.006"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "915"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2017;36:1-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 9982
      "formatos" => array:3 [
        "EPUB" => 223
        "HTML" => 7426
        "PDF" => 2333
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Perspetivas em Cardiologia</span>"
      "titulo" => "Pela melhoria do tratamento da insufici&#234;ncia card&#237;aca em Portugal &#8211; documento de consenso"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "8"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "For the improvement of Heart Failure treatment in Portugal &#8208; Consensus statement"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2430
              "Ancho" => 3346
              "Tamanyo" => 405885
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os fluxos assistenciais em torno da insufici&#234;ncia card&#237;aca evidenciam a necessidade de equipas multidisciplinares&#44; coordenadas&#44; envolvendo os v&#225;rios n&#237;veis do Sistema Nacional de Sa&#250;de e que assegurem o manejo integrado da s&#237;ndrome e prestem cuidados m&#233;dicos conforme as recomenda&#231;&#245;es internacionais&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abreviaturas IC&#58; insufici&#234;ncia card&#237;aca&#46;</p>"
          ]
        ]
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => ""
          "autores" => array:3 [
            0 => array:1 [
              "colaborador" => "Posi&#231;&#227;o de peritos subscrita pelo Grupo de Estudos de Insufici&#234;ncia Card&#237;aca da Sociedade Portuguesa de Cardiologia"
            ]
            1 => array:1 [
              "colaborador" => "N&#250;cleo de Estudos de Insufici&#234;ncia Card&#237;aca da Sociedade Portuguesa de Medicina Interna&#59; Col&#233;gio da Especialidade de Medicina Geral e Familiar da Ordem dos M&#233;dicos"
            ]
            2 => array:1 [
              "colaborador" => "N&#250;cleo de Estudos de Doen&#231;as Cardiovasculares em Medicina Geral e Familiar e N&#250;cleo de Enfermagem em Cardiologia da Sociedade Portuguesa de Cardiologia &#40;Anexo 1&#41;"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => "C&#226;ndida Fonseca, Dulce Brito, Rui Cernadas, Jorge Ferreira, F&#225;tima Franco, Teresa Rodrigues, Jo&#227;o Morais, Jos&#233; Silva Cardoso"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "C&#226;ndida"
              "apellidos" => "Fonseca"
            ]
            1 => array:2 [
              "nombre" => "Dulce"
              "apellidos" => "Brito"
            ]
            2 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Cernadas"
            ]
            3 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Ferreira"
            ]
            4 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Franco"
            ]
            5 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Rodrigues"
            ]
            6 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Morais"
            ]
            7 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Silva Cardoso"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204916302331"
        "doi" => "10.1016/j.repce.2016.10.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302331?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302979?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116302979/v2_201701040047/pt/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S0870255116302906"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2016.10.003"
      "estado" => "S300"
      "fechaPublicacion" => "2017-01-01"
      "aid" => "907"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2017;36:17-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3056
        "formatos" => array:3 [
          "EPUB" => 201
          "HTML" => 2349
          "PDF" => 506
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio Editorial</span>"
        "titulo" => "Cardiotoxicidade subcl&#237;nica em oncologia&#58; o impacto da dete&#231;&#227;o precoce"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "17"
            "paginaFinal" => "19"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Subclinical cardiotoxicity in cancer therapy&#58; The impact of early detection"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ana G&#46; Almeida"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Ana G&#46;"
                "apellidos" => "Almeida"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204916302306"
          "doi" => "10.1016/j.repce.2016.11.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302306?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302906?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116302906/v2_201701040047/pt/main.assets"
    ]
  ]
  "pt" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
    "titulo" => "Import&#226;ncia da deforma&#231;&#227;o longitudinal na dete&#231;&#227;o da cardiotoxicidade induzida por quimioterapia e na identifica&#231;&#227;o de padr&#245;es espec&#237;ficos de afeta&#231;&#227;o segmentar"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "9"
        "paginaFinal" => "15"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Guilherme Portugal, Lu&#237;sa Moura Branco, Ana Galrinho, Miguel Mota Carmo, Ana Teresa Tim&#243;teo, Joana Feliciano, Jo&#227;o Abreu, S&#243;nia Duarte Oliveira, Lurdes Batarda, Rui Cruz Ferreira"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "Guilherme"
            "apellidos" => "Portugal"
            "email" => array:1 [
              0 => "gfportugal&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Lu&#237;sa"
            "apellidos" => "Moura Branco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Galrinho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Miguel"
            "apellidos" => "Mota Carmo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Ana Teresa"
            "apellidos" => "Tim&#243;teo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Joana"
            "apellidos" => "Feliciano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Jo&#227;o"
            "apellidos" => "Abreu"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "S&#243;nia"
            "apellidos" => "Duarte Oliveira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Lurdes"
            "apellidos" => "Batarda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Cruz Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Hospital de Santa Marta&#44; Centro Hospitalar Lisboa Central&#44; EPE&#44; Lisboa&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Oncologia M&#233;dica&#44; Hospital de Santo Ant&#243;nio dos Capuchos&#44; Centro Hospitalar de Lisboa Central&#44; EPE&#44; Lisboa&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Global and regional patterns of longitudinal strain in screening for chemotherapy&#8208;induced cardiotoxicity"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1145
            "Ancho" => 1499
            "Tamanyo" => 94204
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evolu&#231;&#227;o da deforma&#231;&#227;o longitudinal global no ecocardiograma basal e sob quimioterapia para a popula&#231;&#227;o global de doentes&#46; Observa&#8208;se uma deteriora&#231;&#227;o da deforma&#231;&#227;o longitudinal global sob quimioterapia&#46; O valor central representa o valor de GLS m&#233;dio&#59; as barras de erro representam o intervalo de confian&#231;a de 95&#37; para o erro padr&#227;o&#46; QT&#58; quimioterapia&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As antraciclinas e&#44; mais recentemente&#44; o trastuzumab&#44; um anticorpo monoclonal dirigido ao recetor HER2&#44; s&#227;o rotineiramente utilizados no tratamento da neoplasia da mama<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; No entanto&#44; rapidamente se reconheceu que a utiliza&#231;&#227;o destes f&#225;rmacos pode levar &#224; degrada&#231;&#227;o da fun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo&#44; avaliada atrav&#233;s da fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;FEVE&#41; e &#224; instala&#231;&#227;o cl&#237;nica de insufici&#234;ncia card&#237;aca<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; De facto&#44; a cardiotoxicidade induzida por f&#225;rmacos de quimioterapia &#40;CIT&#41; &#233; um dos principais determinantes de progn&#243;stico em sobreviventes a neoplasia da mama<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; embora apenas um pequeno subgrupo de doentes expostos a estas terapias vem a desenvolver CIT&#44; com uma incid&#234;ncia descrita entre 3&#8208;12&#37; para terapia isolada com antraciclinas e at&#233; 28&#37; em combina&#231;&#227;o com trastuzumab&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Neste contexto&#44; s&#227;o necess&#225;rias estrat&#233;gias eficazes para a monitoriza&#231;&#227;o e dete&#231;&#227;o atempada da CIT&#44; com especial foco na melhor compreens&#227;o dos mecanismos de degrada&#231;&#227;o da contractilidade mioc&#225;rdica&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A tecnologia de <span class="elsevierStyleItalic">peckle tracking</span>&#44; hoje dispon&#237;vel comercialmente numa variedade de dispositivos de ecocardiografia&#44; permite uma avalia&#231;&#227;o da deforma&#231;&#227;o do mioc&#225;rdio nos seus diferentes componentes &#8211; longitudinal&#44; radial e circunferencial&#46; De facto&#44; a deteriora&#231;&#227;o da deforma&#231;&#227;o longitudinal global &#40;GLS&#41; em pacientes com fra&#231;&#227;o de eje&#231;&#227;o preservada est&#225; associada &#224; incid&#234;ncia de eventos adversos cardiovasculares numa variedade de contextos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O objetivo dos autores foi caracterizar a evolu&#231;&#227;o da contractilidade mioc&#225;rdica&#44; conforme avaliado pela deforma&#231;&#227;o longitudinal regional e GLS&#44; em doentes submetidos a quimioterapia no tratamento de neoplasia da mama&#46; Adicionalmente&#44; procurou&#8208;se estabelecer se a observa&#231;&#227;o de altera&#231;&#245;es da contractilidade mioc&#225;rdica&#44; precedendo a descida da FEVE&#44; permite prever o desenvolvimento de CIT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Desenho do estudo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Foi efetuado um estudo prospetivo observacional de pacientes com neoplasia da mama submetidos a quimioterapia com antraciclinas&#44; com dose programada &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> de doxorubicina ou equivalente&#44; com ou sem imunoterapia adjuvante&#44; entre junho de 2011 e outubro de 2015&#46; A referencia&#231;&#227;o dos doentes foi efetuada a partir do servi&#231;o de oncologia do centro hospitalar&#46; Foram inclu&#237;dos todos os doentes referenciados para avalia&#231;&#227;o ecocardiogr&#225;fica pr&#233;via ao in&#237;cio da quimioterapia&#44; e seguidos durante o decurso do tratamento de quimioterapia com antraciclinas&#46; Foram exclu&#237;dos os doentes que referissem antecedente pessoal de patologia card&#237;aca&#44; ou com achados com significado patol&#243;gico no ecocardiograma inicial&#44; definida como FEVE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>53&#37;&#44; di&#226;metro telediast&#243;lico do VE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm&#44; espessura das paredes do VE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mm&#44; insufici&#234;ncia valvular moderada ou grave ou presen&#231;a de cardiopatia cong&#233;nita&#46; Foram recolhidos dados demogr&#225;ficos&#44; da terap&#234;utica antineopl&#225;sica em curso&#44; bem como referentes &#224;s vari&#225;veis ecocardiogr&#225;ficas&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Aquisi&#231;&#227;o ecocardiogr&#225;fica e p&#243;s&#8208;processamento</span><p id="par0030" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica inicial e de seguimento foram realizadas de acordo com a indica&#231;&#227;o cl&#237;nica estabelecida pelo oncologista&#46; Os ecocardiogramas foram efetuados num aparelho Vivid 9 ou Vivid 7 da marca GE&#46; Os doentes efetuaram aquisi&#231;&#245;es ecocardiogr&#225;ficas nos planos parasternal longo&#8208;eixo e curto&#8208;eixo&#44; bem como apical quatro c&#226;maras&#44; duas c&#226;maras e tr&#234;s c&#226;maras&#46; Um subgrupo de doentes &#40;99 pacientes&#44; 63&#44;1&#37;&#41; foi tamb&#233;m submetido a an&#225;lise com Doppler tecidular&#46; A FEVE foi avaliada com utiliza&#231;&#227;o do m&#233;todo de Simpson biplanar&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A an&#225;lise de deforma&#231;&#227;o longitudinal foi efetuada <span class="elsevierStyleItalic">off&#8208;line</span> ap&#243;s aquisi&#231;&#227;o das incid&#234;ncias apical tr&#234;s c&#226;maras&#44; duas c&#226;maras e quatro c&#226;maras&#44; utilizando um algoritmo semiautom&#225;tico dispon&#237;vel no <span class="elsevierStyleItalic">software</span> EchoPAC BT 12&#46; Os resultados para a deforma&#231;&#227;o longitudinal foram analisados como avalia&#231;&#227;o regional&#44; utilizando um modelo de 18 segmentos&#44; e a m&#233;dia destes 18 segmentos foi usada para calcular a GLS&#46; A variabilidade interobservador e intraobservador da avalia&#231;&#227;o da deforma&#231;&#227;o longitudinal em pacientes submetidos a quimioterapia com antraciclinas j&#225; foi previamente reportada<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Defini&#231;&#245;es</span><p id="par0040" class="elsevierStylePara elsevierViewall">A CIT foi definida como uma redu&#231;&#227;o da FEVE abaixo de 53&#37;&#44; de acordo com os crit&#233;rios do documento de consenso de 2014 para avalia&#231;&#227;o multimodal em doentes adultos submetidos a quimioterapia da Sociedade Americana de Ecocardiografia &#40;ASE&#41; e a Associa&#231;&#227;o Europeia de Imagiologia Cardiovascular &#40;EACVI&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46; Relativamente &#224; GLS&#44; esta foi definida como estando alterada &#40;menos negativa&#41;&#44; utilizando o limiar recomendado pela ASE&#47;EACVI para o EchoPAC BT 12 de &#8208;18&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lise estat&#237;stica</span><p id="par0045" class="elsevierStylePara elsevierViewall">A an&#225;lise da varia&#231;&#227;o da FEVE e GLS e segmentar foi efetuada comparando o ecocardiograma basal e os ecocardiogramas efetuados durante o seguimento&#46; No caso de existir mais do que um ecocardiograma no per&#237;odo de seguimento&#44; foi utilizado o valor correspondente &#224; maior varia&#231;&#227;o das vari&#225;veis estudadas&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para estudar as vari&#225;veis preditoras de CIT&#44; utilizou&#8208;se uma an&#225;lise de regress&#227;o log&#237;stica para a vari&#225;vel dependente de incid&#234;ncia de CIT durante o seguimento&#44; sendo inclu&#237;das no modelo vari&#225;veis referentes aos dados demogr&#225;ficos&#44; ecocardiograma basal&#44; terap&#234;utica antineopl&#225;sica e a presen&#231;a ou aus&#234;ncia de compromisso do GLS durante o seguimento precedendo o desenvolvimento de CIT&#46; As vari&#225;veis com valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 em an&#225;lise univariada foram inclu&#237;das num modelo multivariado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o entre vari&#225;veis cont&#237;nuas com distribui&#231;&#227;o normal foi efetuada com recurso ao teste de t de Student&#46; A compara&#231;&#227;o entre vari&#225;veis categ&#243;ricas foi efetuada utilizando o teste de qui&#8208;quadrado&#46; Considerou&#8208;se um valor p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 como sendo estatisticamente significativo&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracteriza&#231;&#227;o da popula&#231;&#227;o e seguimento ecocardiogr&#225;fico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Um total de 165 mulheres foram avaliadas&#44; sendo exclu&#237;das sete doentes com disfun&#231;&#227;o VE no ecocardiograma basal&#44; sendo inclu&#237;dos 158 doentes na an&#225;lise final&#46; Observou&#8208;se uma dura&#231;&#227;o de seguimento m&#233;dia de 5&#44;4 meses &#40;1&#8208;48 meses&#41;&#44; com tempo de avalia&#231;&#227;o total de 71&#44;1 pessoa&#8208;anos&#46; Todos os pacientes realizaram no m&#237;nimo dois estudos ecocardiogr&#225;ficos&#44; tendo em m&#233;dia efetuado 3&#44;6 ecocardiogramas&#44; com um intervalo m&#233;dio entre exames de 107 dias&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A idade m&#233;dia foi de 54&#44;6 anos<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;9 anos&#44; com 33&#37; dos doentes submetidos a imunoterapia e 16&#44;5&#37; dos doentes submetidos a radioterapia&#46; As vari&#225;veis ecocardiogr&#225;ficas basais est&#227;o descritas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46; N&#227;o se observaram &#243;bitos de causa cardiovascular&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Incid&#234;ncia de CIT durante o seguimento</span><p id="par0070" class="elsevierStylePara elsevierViewall">A defini&#231;&#227;o de CIT foi previamente referenciada nos m&#233;todos&#46; A incid&#234;ncia de CIT na popula&#231;&#227;o estudada durante o per&#237;odo de seguimento foi de 18&#44;9&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#59; observou&#8208;se uma maior incid&#234;ncia de CIT no subgrupo de doentes submetidos em simult&#226;neo a terap&#234;utica com trastuzumab &#40;38&#44;1 <span class="elsevierStyleItalic">versus</span> 11&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Deforma&#231;&#227;o longitudinal global</span><p id="par0075" class="elsevierStylePara elsevierViewall">Durante o seguimento verificou&#8208;se um agravamento significativo da GLS&#44; passando de um valor basal de &#8208;20&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#37; para &#8208;18&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; t de Student&#41;&#46; Esta deteriora&#231;&#227;o foi mais marcada no subgrupo de doentes que desenvolveram CIT &#40;GLS &#8208;17&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; Considerando toda a popula&#231;&#227;o&#44; observou&#8208;se compromisso contractilidade mioc&#225;rdica numa propor&#231;&#227;o significativa dos doentes&#44; com agravamento da GLS ultrapassando o limiar de &#8208;18&#37; em 61&#44;4&#37; dos doentes &#40;97 doentes&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Dos 97 doentes em que se verificou agravamento da deforma&#231;&#227;o longitudinal&#44; 27 acabaram por desenvolver CIT&#44; enquanto que apenas 3 em 61 doentes com deforma&#231;&#227;o longitudinal preservada desenvolveram CIT &#40;27&#44;8 <span class="elsevierStyleItalic">versus</span> 4&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; qui&#8208;quadrado&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#59; nos doentes que desenvolveram agravamento do GLS e posteriormente CIT&#44; a CIT foi precedida pelo agravamento do GLS numa m&#233;dia de 101 dias&#46; Por regress&#227;o log&#237;stica&#44; o agravamento da GLS esteve associado a uma incid&#234;ncia aumentada de CIT &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93; 7&#44;45&#44; intervalo de confian&#231;a 2&#44;15&#8208;25&#44;8&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Numa an&#225;lise multivariada&#44; as duas vari&#225;veis independentemente associadas &#224; incid&#234;ncia de CIT foram a imunoterapia &#40;OR 3&#44;14&#44; IC 1&#44;21&#8208;8&#44;2&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41; e a diminui&#231;&#227;o da GLS para o <span class="elsevierStyleItalic">cut&#8208;off</span> de &#8208;18&#37; &#40;OR 4&#44;88&#44; IC 1&#44;32&#8208;18&#44;0&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#46; Uma an&#225;lise de subgrupo excluindo doentes submetidos a imunoterapia tamb&#233;m mostrou resultados semelhantes para o risco de desenvolver CIT&#44; caso se verificasse deteriora&#231;&#227;o da GLS &#40;OR 6&#44;24&#44; IC 1&#44;32&#8208;29&#44;3&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Deforma&#231;&#227;o longitudinal regional</span><p id="par0085" class="elsevierStylePara elsevierViewall">Foi poss&#237;vel determinar a deforma&#231;&#227;o longitudinal regional em 93&#44;1&#37; dos segmentos analisados&#44; com menor sucesso no segmento laterobasal &#40;86&#44;1&#37;&#41; e posterobasal &#40;81&#44;4&#37;&#41;&#46; Quando comparado ao ecocardiograma basal&#44; nos ecocardiogramas efetuados sob terap&#234;utica observou&#8208;se uma deteriora&#231;&#227;o da deforma&#231;&#227;o longitudinal regional em dez de 18 segmentos do VE &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figura 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discuss&#227;o</span><p id="par0090" class="elsevierStylePara elsevierViewall">Neste estudo prospetivo de avalia&#231;&#227;o ecocardiogr&#225;fica com deforma&#231;&#227;o longitudinal em doentes com neoplasia da mama submetidos a quimioterapia &#40;QT&#41;&#44; o principal achado foi uma associa&#231;&#227;o independente entre a deteriora&#231;&#227;o da GLS com FEVE preservada e a incid&#234;ncia de CIT&#46; De facto&#44; nos doentes com deteriora&#231;&#227;o do GLS &#40;valor menos negativo que &#8208;18&#37;&#41;&#44; a incid&#234;ncia de CIT foi muito elevada &#40;28&#44;7&#37;&#41;&#46; Embora um valor de GLS preservado n&#227;o tenha exclu&#237;do o desenvolvimento de CIT na nossa popula&#231;&#227;o&#44; trata&#8208;se de um achado que indica um progn&#243;stico mais favor&#225;vel do ponto de vista da fun&#231;&#227;o cardiovascular&#44; apresentando estes doentes uma probabilidade 4&#44;9 vezes menor de desenvolver CIT&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Tanto quanto &#233; conhecimento dos autores&#44; este &#233; o estudo com maior n&#250;mero de doentes alguma vez realizado na avalia&#231;&#227;o da deforma&#231;&#227;o longitudinal na cardiotoxicidade induzida por f&#225;rmacos antineopl&#225;sicos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#46; A nossa popula&#231;&#227;o de doentes &#233; semelhante &#224;s avaliadas em estudos pr&#233;vios de cardiotoxicidade em doentes com neoplasia da mama<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#44;15</span></a>&#44; sugerindo que os nossos dados podem ser utilizados para identificar um subgrupo de alto risco para desenvolvimento de CIT&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Durante o decurso da quimioterapia com antraciclinas observ&#225;mos uma deteriora&#231;&#227;o da GLS&#44; com a maioria dos doentes apresentando pelo menos uma avalia&#231;&#227;o ecocardiogr&#225;fica com GLS abaixo do limiar da normalidade&#46; Esta observa&#231;&#227;o sugere a presen&#231;a de les&#227;o subcl&#237;nica da contractilidade mioc&#225;rdica&#44; mesmo em doentes que n&#227;o desenvolvem CIT&#44; observa&#231;&#227;o suportada por estudos pr&#233;vios com Doppler tecidular<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">16&#44;17</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A utiliza&#231;&#227;o da an&#225;lise segmentar da deforma&#231;&#227;o longitudinal parece vi&#225;vel nesta popula&#231;&#227;o&#44; com an&#225;lise bem&#8208;sucedida em 93&#44;1&#37; dos segmentos avaliados&#44; correspondendo em m&#233;dia a 17 de 18 segmentos por doente&#46; Observou&#8208;se uma deteriora&#231;&#227;o progressiva da deforma&#231;&#227;o regional sob quimioterapia&#44; sendo que esta deteriora&#231;&#227;o envolveu principalmente os segmentos do septo interventricular &#40;seis em seis&#41; e da parede anterior&#44; poupando a parede posterior e a maioria dos segmentos das outras paredes&#46; Este envolvimento preferencial do septo j&#225; foi previamente descrito na avalia&#231;&#227;o ecocardiogr&#225;fica com avalia&#231;&#227;o visual da cin&#233;tica segmentar<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&#44; bem como por RMN card&#237;aca<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&#46; Este achado &#233; tamb&#233;m concordante com um estudo previamente publicado que refere compromisso da deforma&#231;&#227;o longitudinal na parede septal&#44; anteroseptal&#44; anterolateral e apical em 27 doentes submetidos a quimioterapia com antraciclinas<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a>&#46; Embora este achado deva ser validado em estudos futuros&#44; o reconhecimento deste padr&#227;o de envolvimento septal e anterior poder&#225; ser &#250;til na monitoriza&#231;&#227;o da cardiotoxicidade associada &#224; QT&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">O interesse na deforma&#231;&#227;o longitudinal e em t&#233;cnicas precoces de dete&#231;&#227;o de les&#227;o subcl&#237;nica&#44; neste contexto&#44; &#233; sublinhado pelo facto de at&#233; 58&#37; dos doentes com CIT n&#227;o recuperarem uma fun&#231;&#227;o sist&#243;lica normal<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Embora j&#225; existam estudos multic&#234;ntricos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a> e uma meta&#8208;an&#225;lise recente<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#44; suportando a utiliza&#231;&#227;o de t&#233;cnicas de <span class="elsevierStyleItalic">speckle tracking</span> na monitoriza&#231;&#227;o da cardiotoxicidade por antraciclinas e trastuzumab&#44; estas ainda n&#227;o s&#227;o utilizadas de forma regular na pr&#225;tica cl&#237;nica&#46; Os resultados deste estudo est&#227;o em linha com os resultados previamente descritos&#44; refor&#231;ando o valor da deforma&#231;&#227;o longitudinal tanto na avalia&#231;&#227;o da cardiotoxicidade subcl&#237;nica como na sinaliza&#231;&#227;o de doentes de alto risco para desenvolvimento de CIT&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Existem algumas limita&#231;&#245;es a este estudo&#46; O facto de os ecocardiogramas terem sido efetuados por indica&#231;&#227;o cl&#237;nica&#44; ao inv&#233;s de intervalos previamente estabelecidos&#44; pode ter levado &#224; aus&#234;ncia de dados ecocardiogr&#225;ficos que de outra forma teriam sido colhidos de forma sistem&#225;tica em intervalos pr&#233;&#8208;definidos&#46; A dura&#231;&#227;o m&#233;dia de seguimento rondou os seis meses&#44; sendo essa a dura&#231;&#227;o habitual da vigil&#226;ncia ecocardiogr&#225;fica cl&#237;nica durante tratamento com f&#225;rmacos cardiot&#243;xicos&#59; no entanto&#44; observou&#8208;se alguma heterogeneidade na dura&#231;&#227;o de seguimento&#44; que variou entre 1&#8208;48 meses&#46; Por essa raz&#227;o&#44; utilizou&#8208;se como evento de interesse o desenvolvimento de CIT em qualquer momento durante o seguimento&#44; e n&#227;o aos tr&#234;s ou seis meses&#44; uma vez que na pr&#225;tica cl&#237;nica este &#233; o evento relevante&#44; independentemente do per&#237;odo que decorreu entre a QT e a CIT&#46; No entanto&#44; esta abordagem poder&#225; ter levado &#224; subestima&#231;&#227;o da incid&#234;ncia de CIT em doentes com dura&#231;&#227;o de seguimento mais curto&#44; nos quais a exposi&#231;&#227;o &#224; terap&#234;utica com antraciclinas pode n&#227;o ter ainda atingido uma dose cumulativa suficiente para levar a degrada&#231;&#227;o da fun&#231;&#227;o VE&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Outra limita&#231;&#227;o prende&#8208;se com o facto de um ter&#231;o dos doentes apresentar neoplasia da mama HER2 positiva e ter efetuado terap&#234;utica concomitante com trastuzumab&#44; o que limita a generaliza&#231;&#227;o destes resultados para doentes sob terapia isolada com antraciclinas&#46; No entanto&#44; uma an&#225;lise de subgrupo incluindo apenas os doentes submetidos a monoterapia com antraciclinas mostrou resultados semelhantes ao grupo total&#46; Finalmente&#44; n&#227;o temos informa&#231;&#227;o relativa &#224; terap&#234;utica farmacol&#243;gica empregue para a preven&#231;&#227;o ou tratamento da cardiotoxicidade&#44; pelo que a interpreta&#231;&#227;o dos resultados dever&#225; ter este aspeto em conta&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclus&#245;es</span><p id="par0125" class="elsevierStylePara elsevierViewall">A contractilidade mioc&#225;rdica&#44; conforme avaliada por GLS&#44; agravou&#8208;se na maioria dos doentes submetidos a quimioterapia por neoplasia da mama&#46; Esta deteriora&#231;&#227;o parece ter um padr&#227;o de envolvimento preferencial do septo interventricular e parede anterior&#46; O agravamento da GLS em doentes com fra&#231;&#227;o de eje&#231;&#227;o preservada associou&#8208;se de forma independente &#224; incid&#234;ncia de CIT&#44; podendo pois considerar&#8208;se como um detetor mais precoce da cardiotoxicidade do que o c&#225;lculo apenas da fra&#231;&#227;o de eje&#231;&#227;o para a monitoriza&#231;&#227;o&#44; como &#233; classicamente preconizado&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Responsabilidades &#233;ticas</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Prote&#231;&#227;o de pessoas e animais</span><p id="par0130" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidencialidade dos dados</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos do seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Direito &#224; privacidade e consentimento escrito</span><p id="par0140" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflito de interesses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres785504"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introdu&#231;&#227;o e objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclus&#245;es"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec784237"
          "titulo" => "Palavras&#8208;chave"
        ]
        2 => array:3 [
          "identificador" => "xres785503"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec784236"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introdu&#231;&#227;o"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todos"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Desenho do estudo"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Aquisi&#231;&#227;o ecocardiogr&#225;fica e p&#243;s&#8208;processamento"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Defini&#231;&#245;es"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "An&#225;lise estat&#237;stica"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Resultados"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Caracteriza&#231;&#227;o da popula&#231;&#227;o e seguimento ecocardiogr&#225;fico"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Incid&#234;ncia de CIT durante o seguimento"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Deforma&#231;&#227;o longitudinal global"
            ]
            3 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Deforma&#231;&#227;o longitudinal regional"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discuss&#227;o"
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conclus&#245;es"
        ]
        9 => array:3 [
          "identificador" => "sec0070"
          "titulo" => "Responsabilidades &#233;ticas"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Prote&#231;&#227;o de pessoas e animais"
            ]
            1 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Confidencialidade dos dados"
            ]
            2 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Direito &#224; privacidade e consentimento escrito"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Conflito de interesses"
        ]
        11 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-02-10"
    "fechaAceptado" => "2016-06-22"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec784237"
          "palabras" => array:3 [
            0 => "Deforma&#231;&#227;o longitudinal global"
            1 => "Cardiotoxicidade"
            2 => "Trastuzumab"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec784236"
          "palabras" => array:3 [
            0 => "Global longitudinal strain"
            1 => "Cardiotoxicity"
            2 => "Trastuzumab"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A avalia&#231;&#227;o seriada da fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda &#40;FEVE&#41; &#233; o padr&#227;o de refer&#234;ncia na vigil&#226;ncia da cardiotoxicidade induzida por quimioterapia &#40;CIT&#41;&#46; A avalia&#231;&#227;o da deforma&#231;&#227;o longitudinal com t&#233;cnicas de <span class="elsevierStyleItalic">speckle tracking</span> permite uma avalia&#231;&#227;o mais detalhada da contractilidade mioc&#225;rdica&#46; O objetivo deste estudo foi avaliar a rela&#231;&#227;o entre a deforma&#231;&#227;o longitudinal global &#40;GLS&#41; e regional e a incid&#234;ncia de CIT&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 158 pacientes num estudo prospetivo observacional de doentes com neoplasia da mama submetidos a quimioterapia com antraciclinas&#44; com ou sem terap&#234;utica adjuvante com trastuzumab&#46; Foi efetuada uma monitoriza&#231;&#227;o ecocardiogr&#225;fica seriada de par&#226;metros de fun&#231;&#227;o sist&#243;lica e diast&#243;lica&#44; incluindo a avalia&#231;&#227;o da deforma&#231;&#227;o mioc&#225;rdica longitudinal bidimensional&#46; A incid&#234;ncia de CIT foi definida como uma diminui&#231;&#227;o da FEVE para valor<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>53&#37;&#44; de acordo com o documento de consenso da Sociedade Europeia de Imagiologia Cardiovascular &#40;EACVI&#41;&#46; Os doentes foram classificados como tendo deteriora&#231;&#227;o da contractilidade mioc&#225;rdica para um valor de GLS menos negativo que &#8208;18&#37;&#44; de acordo com os crit&#233;rios da EACVI&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Durante um per&#237;odo de seguimento m&#233;dio de 5&#44;4 meses &#40;1&#8208;48 meses&#41;&#44; a incid&#234;ncia de CIT foi de 18&#44;9&#37;&#46; Na popula&#231;&#227;o global observou&#8208;se uma deteriora&#231;&#227;o significativa do GLS durante o tratamento com quimioterapia &#40;&#8208;20&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 18&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; com compromisso do GLS detetado durante em algum per&#237;odo do seguimento em 61&#44;4&#37; dos doentes&#46; Esta deteriora&#231;&#227;o foi mais marcada no subgrupo de doentes com CIT &#40;GLS&#58; &#8208;17&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; Na an&#225;lise regional da deforma&#231;&#227;o longitudinal&#44; verificou&#8208;se compromisso da contractilidade envolvendo preferencialmente os segmentos septais &#40;seis em seis&#41; e parede anterior &#40;dois em tr&#234;s&#41;&#46; Por regress&#227;o log&#237;stica multivariada&#44; o compromisso do GLS esteve independentemente associado ao desenvolvimento de CIT &#40;<span class="elsevierStyleItalic">odds ratio</span> 4&#44;88&#44; IC 1&#44;32&#8208;18&#44;0&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O compromisso da deforma&#231;&#227;o longitudinal &#233; frequente em doentes submetidos a quimioterapia e mostrou um padr&#227;o de distribui&#231;&#227;o predominante a n&#237;vel septal e anterior&#46; A degrada&#231;&#227;o da GLS foi um preditor independente de CIT&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Serial echocardiographic assessment of left ventricular ejection fraction &#40;LVEF&#41; is the gold standard in screening for chemotherapy&#8208;induced cardiotoxicity &#40;CIC&#41;&#46; Measurement of myocardial deformation using speckle tracking enables more detailed assessment of myocardial contractility&#46; The aim of this study was to determine the relationship between global and regional longitudinal strain and CIC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a prospective study of 158 breast cancer patients undergoing chemotherapy with anthracyclines with or without adjuvant trastuzumab who underwent serial monitoring by transthoracic echocardiography with assessment of myocardial deformation&#46; CIC was defined as a decrease in LVEF to &#60;53&#37;&#46; Global longitudinal strain &#40;GLS&#41; was estimated using EchoPAC BT12 software on a GE Vivid E9 cardiac ultrasound system&#46; Patients were classified according to the 2015 ASE&#47;EACVI criteria as having impaired myocardial deformation when GLS was reduced &#40;less negative&#41;&#44; with a cutoff of &#8208;18&#37;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">During a mean follow&#8208;up of 5&#46;4 months &#40;1&#8208;48 months&#41;&#44; the incidence of CIC was 18&#46;9&#37;&#46; A decrease in GLS was observed during follow&#8208;up for the entire cohort &#40;baseline GLS &#8208;20&#46;1&#177;3&#46;5&#37; vs&#46; &#8208;18&#46;7&#177;3&#46;4&#37; at last follow&#8208;up assessment&#44; p&#61;0&#46;001&#41;&#46; A total of 97 patients &#40;61&#46;4&#37;&#41; were observed to have impaired myocardial deformation &#40;GLS &#8805;18&#37;&#41; at some point during follow&#8208;up&#46; This decrease was more significant in patients who eventually developed CIC &#40;GLS &#8208;17&#46;2&#177;2&#46;5&#37;&#44; p&#61;0&#46;02&#41;&#46; On analysis of regional strain&#44; impaired contractility was observed in the septal &#40;6 out of 6&#41; and anterior &#40;2 out of 3&#41; segments&#46; Multivariate logistic regression showed that patients who developed impaired longitudinal strain had a 4&#46;9&#8208;fold increased risk of developing CIC &#40;odds ratio 4&#46;88&#44; confidence interval 1&#46;32&#8208;18&#46;0&#44; p&#61;0&#46;017&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Worsening of myocardial deformation as assessed by speckle tracking is common in breast cancer patients undergoing chemotherapy&#44; with predominantly septal and anterior wall involvement&#46; Impaired myocardial deformation was independently associated with increased incidence of CIC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1065
            "Ancho" => 1546
            "Tamanyo" => 55427
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sobrevida livre de cardiotoxicidade induzida por quimioterapia &#40;CIT&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1145
            "Ancho" => 1499
            "Tamanyo" => 94204
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evolu&#231;&#227;o da deforma&#231;&#227;o longitudinal global no ecocardiograma basal e sob quimioterapia para a popula&#231;&#227;o global de doentes&#46; Observa&#8208;se uma deteriora&#231;&#227;o da deforma&#231;&#227;o longitudinal global sob quimioterapia&#46; O valor central representa o valor de GLS m&#233;dio&#59; as barras de erro representam o intervalo de confian&#231;a de 95&#37; para o erro padr&#227;o&#46; QT&#58; quimioterapia&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1411
            "Ancho" => 1556
            "Tamanyo" => 107092
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Incid&#234;ncia de CIT ap&#243;s estratifica&#231;&#227;o por doentes&#44; em que se verificou ou n&#227;o deteriora&#231;&#227;o da deforma&#231;&#227;o longitudinal global&#46; Nos doentes com agravamento da DL durante seguimento existe uma incid&#234;ncia significativamente maior de CIT&#46; As barras de erro representam o intervalo de confian&#231;a de 95&#37; calculado atrav&#233;s do m&#233;todo binomial&#46; CIT&#58; cardiotoxicidade induzida por quimioterapia&#59; DL&#58; deforma&#231;&#227;o longitudinal&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1450
            "Ancho" => 1450
            "Tamanyo" => 153846
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Deteriora&#231;&#227;o da deforma&#231;&#227;o regional sob quimioterapia com antraciclinas&#46; Os segmentos em que se verificou uma deteriora&#231;&#227;o significativa da deforma&#231;&#227;o regional &#40;teste t de Student&#41; est&#227;o codificados a verde&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Idade &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;6&#177;12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Sexo feminino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">158 &#40;100&#37;&#41;</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">Quimioterapia com antraciclinas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">158 &#40;100&#37;&#41;</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">Imunoterapia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">52 &#40;33&#37;&#41;</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">Radioterapia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">26 &#40;16&#44;5&#37;&#41;</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">Dura&#231;&#227;o de seguimento &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">5&#44;4 &#40;1&#8208;48 meses&#41;</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">&#211;bito de causa oncol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">4 &#40;2&#44;5&#37;&#41;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1305642.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis ecocardiogr&#225;ficas&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">M&#233;dia&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">Desvio padr&#227;o&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">Di&#226;metro telediast&#243;lico VE &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;3&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">Di&#226;metro telessist&#243;lico VE &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;6&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">Fra&#231;&#227;o de encurtamento &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;2&#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">FEVE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4&#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">Volume telediast&#243;lico VE &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&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">Volume telessist&#243;lico VE &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;6&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">Velocidade onda E transmitral &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;6&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">Velocidade onda A transmitral &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;2&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">R&#225;cio E&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33&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">S&#8217; septal &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;77&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">S&#8217; lateral &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;45&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">S&#8217; tric&#250;spide &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5&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">R&#225;cio E&#47;e&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1305639.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basais</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Sem CIT&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">CIT&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">Total&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">Deforma&#231;&#227;o longitudinal preservada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;36&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;38&#44;6&#37;&#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">Agravamento da deforma&#231;&#227;o longitudinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;44&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;17&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;61&#44;4&#37;&#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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128 &#40;81&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1305640.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracteriza&#231;&#227;o de desenvolvimento de CIT e compromisso da deforma&#231;&#227;o longitudinal durante seguimento</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">An&#225;lise univariada&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">p<span class="elsevierStyleHsp" style=""></span>&#61;&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">An&#225;lise multivariada&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">p<span class="elsevierStyleHsp" style=""></span>&#61;&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" title="table-entry  " rowspan="2" align="left" valign="top">Idade</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Odds ratio</span> &#40;OR&#41; 1&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;832</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">CI 0&#44;95&#8208;1&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Trastuzumab</td><td class="td" title="table-entry  " align="left" valign="top">OR 4&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">OR 3&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">0&#44;</span>018</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CI 1&#44;87&#8208;10&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IC 1&#44;21&#8208;8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Radioterapia</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">OR</span> 2&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;079</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">CI 0&#44;90&#8208;6&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Volume telediast&#243;lico</td><td class="td" title="table-entry  " align="left" valign="top">OR 0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;665</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">CI 0&#44;97&#8208;1&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Fra&#231;&#227;o de eje&#231;&#227;o VE basal</td><td class="td" title="table-entry  " align="left" valign="top">OR 0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;186</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">CI 0&#44;00&#8208;8&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Desenvolvimento de compromisso de GLS &#40;&#62;<span class="elsevierStyleHsp" style=""></span>&#8208;18&#37;&#41;</td><td class="td" title="table-entry  " align="left" valign="top">OR 7&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;002</td><td class="td" title="table-entry  " align="left" valign="top">OR 4&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;017</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CI 2&#44;15&#8208;25&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IC 1&#44;32&#8208;18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1305641.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise univariada e multivariada de preditores de CIT</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daunomycin&#44; an antitumor antibiotic&#44; in the treatment of neoplastic disease&#46; Clinical evaluation with special reference to childhood leukemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Tan"
                            1 => "H&#46; Tasaka"
                            2 => "K&#46;P&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer&#46;"
                        "fecha" => "1967"
                        "volumen" => "20"
                        "paginaInicial" => "333"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4290058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2&#8208;positive early breast cancer&#58; a 4&#8208;year follow&#8208;up of a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Gianni"
                            1 => "U&#46; Dafni"
                            2 => "R&#46;D&#46; Gelber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(11)70033-X"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Oncol&#46;"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "236"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21354370"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109714060070"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adriamycin&#58; a new antibiotic with antitumor activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Di Marco"
                            1 => "M&#46; Gaetani"
                            2 => "B&#46; Scarpinato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Chemother Rep&#46;"
                        "fecha" => "1969"
                        "volumen" => "53"
                        "paginaInicial" => "33"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5772652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long&#8208;term assessment of cardiac function after dose&#8208;dense and &#8208;intense sequential doxorubicin &#40;A&#41;&#44; paclitaxel &#40;T&#41;&#44; and cyclophosphamide &#40;C&#41; as adjuvant therapy for high risk breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;M&#46; Abu-Khalaf"
                            1 => "V&#46; Juneja"
                            2 => "G&#46;G&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10549-006-9413-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Breast Cancer Res Treat&#46;"
                        "fecha" => "2007"
                        "volumen" => "104"
                        "paginaInicial" => "341"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17051423"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "5"
              "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemotherapy and cardiotoxicity in older breast cancer patients&#58; a population&#8208;based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; Doyle"
                            1 => "A&#46;I&#46; Neugut"
                            2 => "J&#46;S&#46; Jacobson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2005.02.5841"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "8597"
                        "paginaFinal" => "8605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16314622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long&#8208;term risk of cardiovascular disease in 10&#8208;year survivors of breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Hooning"
                            1 => "A&#46; Botma"
                            2 => "B&#46;M&#46;P&#46; Aleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jnci/djk064"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst&#46;"
                        "fecha" => "2007"
                        "volumen" => "99"
                        "paginaInicial" => "365"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17341728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic importance of impaired systolic function in heart failure with preserved ejection fraction and the impact of spironolactone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Shah"
                            1 => "B&#46; Claggett"
                            2 => "N&#46;K&#46; Sweitzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.115.015884"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2015"
                        "volumen" => "132"
                        "paginaInicial" => "402"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26130119"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "quiz 453&#8208;455"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of myocardial mechanics using speckle tracking echocardiography&#58; fundamentals and clinical applications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Geyer"
                            1 => "G&#46; Caracciolo"
                            2 => "H&#46; Abe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2010.02.015"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Soc Echocardiogr&#46;"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "351"
                        "paginaFinal" => "369"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20362924"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1053077015001238"
                          "estado" => "S300"
                          "issn" => "10530770"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interobserver&#44; intraobserver and intrapatient reliability scores of myocardial strain imaging with 2&#8208;d echocardiography in patients treated with anthracyclines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;M&#46;C&#46; Mavinkurve-Groothuis"
                            1 => "G&#46; Weijers"
                            2 => "J&#46; Groot-Loonen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ultrasmedbio.2008.09.026"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ultrasound Med Biol&#46;"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "697"
                        "paginaFinal" => "704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19097680"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1053077015001330"
                          "estado" => "S300"
                          "issn" => "10530770"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    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"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Plana"
                            1 => "M&#46; Galderisi"
                            2 => "A&#46; Barac"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2014.07.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr&#46;"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "911"
                        "paginaFinal" => "939"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25172399"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for cardiac chamber quantification by echocardiography in adults&#58; an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;M&#46; Lang"
                            1 => "L&#46;P&#46; Badano"
                            2 => "V&#46; Mor-Avi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ehjci/jev014"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J Cardiovasc Imaging&#46;"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "233"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712077"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S014067360961343X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Thavendiranathan"
                            1 => "F&#46; Poulin"
                            2 => "K-D&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2014.01.073"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2014"
                        "volumen" => "63"
                        "paginaInicial" => "2751"
                        "paginaFinal" => "2768"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24703918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of carvedilol on silent anthracycline&#8208;induced cardiotoxicity assessed by strain imaging&#58; A prospective randomized controlled study with six&#8208;month follow&#8208;up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Elitok"
                            1 => "F&#46; Oz"
                            2 => "A&#46;Y&#46; Cizgici"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol J&#46;"
                        "fecha" => "2014"
                        "volumen" => "2"
                        "paginaInicial" => "509"
                        "paginaFinal" => "515"
                        "itemHostRev" => array:3 [
                          "pii" => "S2352302615001982"
                          "estado" => "S300"
                          "issn" => "23523026"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline&#8208;Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Lange"
                            1 => "J&#46; Jung"
                            2 => "A&#46; Jaeck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12012-015-9328-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Toxicol&#46;"
                        "fecha" => "2016"
                        "volumen" => "16"
                        "paginaInicial" => "193"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26022230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tissue Doppler and myocardial deformation imaging to detect myocardial dysfunction in pediatric cancer patients treated with high doses of anthracyclines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Ya&#287;ci-K&#252;peli"
                            1 => "A&#46; Varan"
                            2 => "H&#46; Yorgun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1743-7563.2012.01566.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Asia Pac J Clin Oncol&#46;"
                        "fecha" => "2012"
                        "volumen" => "8"
                        "paginaInicial" => "368"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22898185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac functional evaluation using vector velocity imaging after chemotherapy including anthracyclines in children with cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Park"
                            1 => "Y&#46;H&#46; Kim"
                            2 => "M&#46;C&#46; Hyun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4070/kcj.2009.39.9.352"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean Circ J&#46;"
                        "fecha" => "2009"
                        "volumen" => "39"
                        "paginaInicial" => "352"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19949618"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiotoxicity associated with cancer therapy&#58; pathophysiology and prevention strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Ad&#227;o"
                            1 => "G&#46; de Keulenaer"
                            2 => "A&#46; Leite-Moreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2012.11.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol&#46;"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "395"
                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23623503"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac MRI in the assessment of cardiac injury and toxicity from cancer chemotherapy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Thavendiranathan"
                            1 => "B&#46;J&#46; Wintersperger"
                            2 => "S&#46;D&#46; Flamm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.113.000899"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging&#46;"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "1080"
                        "paginaFinal" => "1091"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24254478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early detection and prediction of cardiotoxicity in chemotherapy&#8208;treated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Sawaya"
                            1 => "I&#46;A&#46; Sebag"
                            2 => "J&#46;C&#46; Plana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2011.01.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "107"
                        "paginaInicial" => "1375"
                        "paginaFinal" => "1380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21371685"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines&#44; taxanes&#44; and trastuzumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Sawaya"
                            1 => "I&#46;A&#46; Sebag"
                            2 => "J&#46;C&#46; Plana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.112.973321"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging&#46;"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "596"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22744937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116302165/v2_201701040047/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29261"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos Originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000001/v2_201701040047/S0870255116302165/v2_201701040047/pt/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302165?idApp=UINPBA00004E"
]