Original Article
Short- and medium-term prognosis of Takotsubo syndrome in a Portuguese population
Prognóstico a curto e médio prazo da síndrome de Takotsubo numa população portuguesa
Dina Bentoa,b,
, Olga Azevedoc, Rui Santosd, Ana Almeidae, Kevin Dominguesf, Bruno Marmelog, Liliana Reish, Catarina Ruivoi, Rui Guerreiroj, Rui Limak, Ricardo Fariac, Ana Marreirosb,l, Nuno Marquesa,b,l, on behalf of the SUNSHINE Investigators group
Autor para correspondência
a Cardiology Department, Centro Hospitalar Universitário do Algarve Faro, Portugal
b Algarve Biomedical Center, Faro, Portugal
c Cardiology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
d Cardiology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
e Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
f Cardiology Department, Hospital de Santarém, Santarém, Portugal
g Cardiology Department, Centro Hospitalar Tondela-Viseu, Portugal
h Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
i Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal
j Cardiology Department, Hospital do Espírito Santo, Évora, Portugal
k Cardiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
l Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
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Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Cardiology Department, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Cardiology Department, Hospital de Santarém, Santarém, Portugal" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar Tondela-Viseu, Portugal" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Cardiology Department, Hospital do Espírito Santo, Évora, Portugal" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Cardiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal" "etiqueta" => "l" "identificador" => "aff0060" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prognóstico a curto e médio prazo da síndrome de Takotsubo numa população portuguesa" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome (TTS) was first described in the Japanese population in the early 1990s. It takes its name from the Japanese octopus trap named <span class="elsevierStyleItalic">takotsubo</span> because the left ventricle in systole takes a similar shape to the trap.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The syndrome is characterized by transient left ventricular (LV) systolic dysfunction, electrocardiographic changes that mimic acute myocardial infarction and minimal release of myocardial necrosis enzymes, in the absence of obstructive coronary artery disease (CAD).<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a> It has been estimated to account for 1-2% of cases of suspected acute coronary syndrome (ACS).<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">3</span></a> However, this figure is probably an underestimate.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In other series, 90% of patients were female and aged over 50 years. In about two-thirds of cases, there was an emotional or physical triggering factor.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The underlying mechanism of TTS is not fully understood. However, the most commonly accepted theory is of catecholamine-induced cardiotoxicity in response to an emotional or physical stimulus.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical presentation is very similar to an ACS, and TTS needs a differential workup to distinguish between the two entities. To establish a diagnosis of TTS, coronary angiography is needed to exclude obstructive CAD as the cause of LV dysfunction.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most commonly used diagnostic criteria for TTS are those proposed by the Mayo Clinic.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a> The Heart Failure Association of the European Society of Cardiology recently published updated diagnostic criteria<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a> that distinguish between primary and secondary TTS. In the primary subtype, cardiac symptoms are the primary reason for seeking medical care, while in the secondary subtype the patient has an underlying primary disease that precipitated TTS.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapy is supportive, usually consisting of vasodilators, beta-blockers and diuretics.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although the syndrome has previously been described as benign, more recent series have revealed a significant rate of in-hospital complications, and the short- and medium-term prognosis may be less favorable than previously described.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The aim of this study was to characterize a Portuguese population with TTS and to determine their short- and medium-term prognosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient population</span><p id="par0050" class="elsevierStylePara elsevierViewall">In this observational multicenter study involving 12 Portuguese hospitals, all patients diagnosed with TTS from 2002 to 2016 were included, retrospectively until 2012 and prospectively since 2012.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were selected according to the Mayo Clinic diagnostic criteria: transient abnormality in LV wall motion beyond a single epicardial coronary artery perfusion territory; absence of obstructive CAD or angiographic evidence of acute plaque rupture; new electrocardiographic abnormalities or modest elevation in cardiac troponin levels; and the absence of pheochromocytoma or myocarditis.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">An exception to these criteria was the inclusion of patients who died during the acute phase, prior to complete recovery of myocardial function.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data collection</span><p id="par0065" class="elsevierStylePara elsevierViewall">The data were collected by consulting the clinical records of patients diagnosed with TTS, retrospectively before 2012 and prospectively after 2012.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Demographic data, personal history, cardiovascular risk factors, triggering factors, clinical presentation, electrocardiographic findings, coronary angiography findings and complications during hospitalization were collected. Coronary angiography was performed in all patients.</p><p id="par0075" class="elsevierStylePara elsevierViewall">TTS was classified as apical, midventricular, basal or focal according to the LV ballooning pattern on the transthoracic echocardiogram.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Chronic kidney disease (CKD) was defined as glomerular filtration rate <60 ml/min for at least three months.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">QT interval was measured by each patient's cardiologist. Corrected QT interval (QTc) was calculated using Bazett's formula and was defined as prolonged if >450 ms for males and >470 ms for females.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography was performed on admission, at discharge and during follow-up. Complete echocardiographic recovery was defined as the normalization of regional wall motion abnormalities present on the initial transthoracic echocardiogram.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The in-hospital complications included were acute heart failure, cardiogenic shock, new-onset atrial fibrillation (AF), ventricular fibrillation/ventricular tachycardia, complete atrioventricular block, stroke/transient ischemic attack (TIA), LV thrombus and death from any cause.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Acute heart failure was defined as the presence of dyspnea, pulmonary edema and/or oxygen desaturation requiring drug therapy and/or mechanical support.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cardiogenic shock was defined as systolic blood pressure <90 mmHg with signs of tissue hypoperfusion requiring inotropic agents and/or fluid therapy.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Follow-up data were obtained from clinical visits, medical records and telephone interviews.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The follow-up analysis included all-cause mortality, cardiovascular mortality and major cardiovascular events (stroke/TIA, myocardial infarction and recurrence of TTS).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cardiovascular mortality was defined as death caused by heart failure, arrhythmia, myocardial infarction, cerebrovascular disease, pulmonary embolism or sudden cardiac death. Any death not covered by these definitions was defined as non-cardiovascular mortality.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Myocardial infarction was defined using the criteria of the third universal definition of myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0130" class="elsevierStylePara elsevierViewall">A descriptive analysis was carried out to characterize the sample profile. Continuous variables are presented as means and standard deviation and categorical variables are presented as percentages.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The chi-square test was used to analyze associations between categorical variables, and the Student's, Mann-Whitney and Kruskal-Wallis tests were applied to continuous variables. The Kolmogorov-Smirnov test was used to verify normality of distribution.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Binary logistic regression was used to measure predictors of in-hospital and follow-up events.</p><p id="par0145" class="elsevierStylePara elsevierViewall">A p-value <0.05 (significance level of 95%) was considered statistically significant. The statistical analysis was performed using IBM SPSS version 24.0.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Baseline characteristics of the study population</span><p id="par0150" class="elsevierStylePara elsevierViewall">The baseline characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A total of 234 patients with TTS were included, 210 (89.7%) female, mean age 68±12 years. In 65% of the patients a triggering factor was identified, emotional stress in 46.6% and physical stress in 18.4%. On admission, chest pain was the most frequent symptom (87.2%), followed by dyspnea (21.8%) and syncope (5.6%). The admission electrocardiogram (ECG) revealed negative T waves in 40.2%, ST-segment elevation in 17.9% and prolonged QTc in 10.3%.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In 12.9% of the patients, coronary angiography identified significant CAD in myocardial areas not corresponding to the wall motion abnormalities found on the transthoracic echocardiogram.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Regarding the classification of TTS, the apical form was the most frequent (77.8%), followed by midventricular (15.8%).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical complications during hospitalization</span><p id="par0170" class="elsevierStylePara elsevierViewall">Complications and interventions during hospitalization are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">During hospitalization, 32.9% of the patients had complications, of which acute heart failure was the most frequent (24.4%).</p><p id="par0180" class="elsevierStylePara elsevierViewall">Regarding intensive care measures, 8.1% of patients received inotropic support and 3.4% underwent mechanical ventilation.</p><p id="par0185" class="elsevierStylePara elsevierViewall">During hospitalization, 49.1% of patients completely recovered LV function, while five (2.2%) died.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Factors associated with complications were history of heart failure (p<0.001), CKD (p=0.001), physical stress as triggering factor (p=0.036), presentation without chest pain (p=0.001), presentation with dyspnea (p<0.001), presence of atherosclerotic lesions in the epicardial coronary arteries (p=0.013), and lower left ventricular ejection fraction (LVEF) on admission transthoracic echocardiography (p<0.001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">In multivariate analysis, the presence of atherosclerotic lesions in the coronary arteries (p=0.027), lower LVEF on admission (p=0.003), CKD (p=0.02) and clinical presentation with dyspnea (p=0.019) were independent predictors of in-hospital clinical complications (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Clinical complications during follow-up</span><p id="par0200" class="elsevierStylePara elsevierViewall">At the mean follow-up of 33±33 months, 12.2% of the patients had complications.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In 4.4% of patients there was recurrence of TTS, 3.1% had stroke/TIA and 0.4% had myocardial infarction. All-cause mortality was 4.4% and cardiovascular mortality was 0.9% (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">Prolonged QTc on the admission ECG was associated with clinical complications at follow-up (p=0.001) (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0215" class="elsevierStylePara elsevierViewall">Our multicenter study of TTS patients is one of the largest and its follow-up is among the longest.</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Baseline characteristics</span><p id="par0220" class="elsevierStylePara elsevierViewall">The baseline characteristics of our study population were similar to other series with respect to mean age of diagnosis (68±12 years) and the predominance of female gender (90%). TTS more frequently affects women over 50 years of age.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,12–14</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Regarding cardiovascular risk factors, hypertension was the most prevalent (68%), followed by dyslipidemia (54%). The prevalence of these factors is in line with that expected for the age group of patients with TTS.</p><p id="par0230" class="elsevierStylePara elsevierViewall">Only 18% of our patients had been diagnosed with diabetes, which is in agreement with the prevalence reported by other series (5-25%).<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,12–17</span></a> Patients with TTS have a lower prevalence of diabetes compared to patients with acute coronary syndrome.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">18</span></a> It is not known whether the presence of diabetes is a protective factor for TTS, but this is possible in view of the hypothesis that the autonomic neuropathy of diabetes may influence the myocardial response to an adrenergic storm.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Clinical presentation</span><p id="par0235" class="elsevierStylePara elsevierViewall">Chest pain is the most common form of clinical presentation of TTS. In our cohort, 87% of the patients presents with chest pain, as in the series by Eitel et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">19</span></a> (88%) and Núñez-Gil et al.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">20</span></a> (90.2%). Other series reported slightly lower rates, between 69% and 81%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,13,14,17,21</span></a> Dyspnea is the second most frequent symptom associated with TTS, with a wide range of prevalences ranging between 8% and 47%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,13,14,17,21–24</span></a> In our cohort, dyspnea was the predominant symptom in 21.8% of the patients.</p><p id="par0240" class="elsevierStylePara elsevierViewall">As for the triggering factor, emotional stress was the most common (46.6%), as also observed in the studies by Yayehd et al.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">14</span></a> (45%) and Prevital et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> (36%). However, other studies found that physical factors were more important than emotional factors.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,12,13,19,25</span></a> In about one third of our patients, no triggering factor was identified, as in several published studies.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,12,13,23,25</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Electrocardiogram</span><p id="par0245" class="elsevierStylePara elsevierViewall">Negative T waves were the most frequent finding on the admission ECG (40.2%). Other series reported similar rates.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,19,20,23</span></a> However, there are some differences between our data and the literature with regard to ST-segment elevation. In our study, only 17.9% of patients had ST-segment elevation, but other series reported higher rates (38-44%).<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,19,23</span></a> In our cohort, 17.9% of the patients had pathological Q waves on the admission ECG, while in Yayehd et al.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">14</span></a> and Schneider et al.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> this figure was 29%. In the study by Schneider et al.,<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> pathological Q waves were a predictor of complications during hospitalization. However, further studies are needed to understand their prognostic impact in TTS patients.</p><p id="par0250" class="elsevierStylePara elsevierViewall">Prolonged QTc was found in 10.3% of our patients on the initial ECG. Some studies have reported an association between TTS and prolonged QTc, however the prevalence of this association is unknown.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">26–29</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Electrocardiographic changes in TTS are dynamic and differences in time from symptom onset to admission may explain the discrepancies between studies.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Biomarkers of myocardial necrosis</span><p id="par0260" class="elsevierStylePara elsevierViewall">The majority of our TTS patients had troponin elevation during hospitalization (89.7%), which is in line with other published series, although these use different types of troponin with different units of measurement, which hampers comparisons of the extent of elevation and consequently the interpretation of its clinical significance.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,14,16,17,19,23,24</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Left ventricular ejection fraction</span><p id="par0265" class="elsevierStylePara elsevierViewall">TTS is characterized by the presence of LV systolic dysfunction at hospital admission.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">In our population, mean LVEF on admission was similar to other series (43±11%).<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,14,17,20,23,30</span></a> This suggests that patients with TTS suffer myocardial stunning of similar magnitude, regardless of differences in other clinical variables.</p><p id="par0275" class="elsevierStylePara elsevierViewall">At hospital discharge, 49.1% of the patients showed recovery of myocardial function, which was complete in all patients at follow-up, in accordance with the diagnostic criteria of TTS.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Classification of Takotsubo syndrome</span><p id="par0280" class="elsevierStylePara elsevierViewall">Concerning the classification of TTS, the apical type was the most frequent (77.8%) followed by midventricular (15.8%) and basal (1.7%), similar findings to those in other series.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,24,30</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Coronary artery disease</span><p id="par0285" class="elsevierStylePara elsevierViewall">TTS and CAD are not mutually exclusive. Given the mean age at diagnosis and the prevalence of cardiovascular risk factors, CAD can coexist with TTS.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">31</span></a> In our cohort, 12.9% of patients had concomitant CAD. In the literature, reported rates are between 9.8% and 19%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,25,31–34</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Clinical complications during hospitalization</span><p id="par0290" class="elsevierStylePara elsevierViewall">Initially, TTS was described as a benign condition.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a> However, more recent series have shown high rates of in-hospital complications that should not be overlooked (21.8-52%).<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,21,22,30,35,36</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">In our population, 32.9% of patients presented complications, of which acute heart failure was the most common (24.4%). In fact, acute heart failure is the main clinical complication in TTS, with rates reported in the literature between 16% and 44%.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">15–17,20,25,35,37</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">In the heart failure spectrum, cardiogenic shock is the most severe manifestation. In our study, this complication occurred in 8.1% of patients, while other studies report rates between 4.7% and 12.4%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,13,15,30,34,36</span></a> Due to the reversibility of LV dysfunction, it could be expected that cardiogenic shock in TTS would have a lower prognostic impact than in ACS, but Stiermaier et al.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a> demonstrated that it is associated with higher short- and long-term mortality.</p><p id="par0305" class="elsevierStylePara elsevierViewall">AF was the most common arrhythmia in our cohort, being found in 15% of our patients, with other series reporting rates between 6% and 15%.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13,21,24,38,39</span></a> El-Battrawy et al.<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">39</span></a> demonstrated that the presence of previously known or first diagnosed AF is associated with higher mortality, both in-hospital and in long-term follow-up.</p><p id="par0310" class="elsevierStylePara elsevierViewall">In our population, 2.6% of the patients had ventricular arrhythmias, a lower figure than in other series, such as Citro et al.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a> (4.5%) and Schneider et al.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> (8%).</p><p id="par0315" class="elsevierStylePara elsevierViewall">Complete atrioventricular block, stroke and LV thrombus are less frequent clinical complications, with rates ranging from 0.6% to 3.8%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,15,21,23,37,40</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Predictors of in-hospital clinical complications</span><p id="par0320" class="elsevierStylePara elsevierViewall">In our cohort, a history of CKD (p=0.02), clinical presentation with dyspnea (p=0.019), atherosclerotic lesions in the epicardial coronary arteries, and lower LVEF on admission (p=0.003) were predictors of in-hospital clinical complications.</p><p id="par0325" class="elsevierStylePara elsevierViewall">CKD is known to be associated with worse cardiovascular prognosis.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">41</span></a> However, to our knowledge, this association has not yet been reported in TTS.</p><p id="par0330" class="elsevierStylePara elsevierViewall">To our knowledge, our work is the first to identify CAD as a predictor of in-hospital complications in patients with TTS. Parodi et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">31</span></a> found no differences in short- and medium-term prognosis in patients with CAD, whereas Bill et al.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">33</span></a> identified this factor as a predictor of medium-term all-cause mortality.</p><p id="par0335" class="elsevierStylePara elsevierViewall">LV systolic dysfunction would be expected to be associated with a worse outcome. In the study by Citro et al.,<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">24</span></a> LVEF was a predictor of heart failure, and in series by Schneider et al.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> and Ribeiro et al.,<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> LVEF of ≤30% and ≤35%, respectively, predicted in-hospital complications.</p><p id="par0340" class="elsevierStylePara elsevierViewall">Templin et al.,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a> studying 1750 patients, identified LVEF on admission, physical stress, troponin level and neurological or psychiatric disease as predictors of complications.</p><p id="par0345" class="elsevierStylePara elsevierViewall">Other series, with significantly smaller numbers of patients, have identified other predictors, such as the presence of pathological Q waves on admission,<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> age ≥75 years,<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a> brain natriuretic peptide and white blood cell count,<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a> heart rate, and sum of ST-segment elevation on the 12-lead ECG.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">Differences in sample sizes and in the characteristics of study populations result in the identification of different predictors of complications. This makes it difficult to accurately stratify in-hospital risk for TTS patients.</p><p id="par0355" class="elsevierStylePara elsevierViewall">Our series constitutes the second largest series of TTS patients in which predictors of in-hospital complications are identified.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">In-hospital mortality</span><p id="par0360" class="elsevierStylePara elsevierViewall">In-hospital mortality in our population was 2.2%, a relatively low figure considering the high rate of acute complications. Other studies report rates between 0% and 12.2%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,13–16,21,24,25,32,42,43</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">Asian series<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">25,32,42,43</span></a> have higher mortality (8.4-12.2%), probably due to differences in the baseline characteristics of the included patients, such as higher percentages of male gender and physical stress as a triggering factor. In support of this hypothesis, Sobue et al.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">42</span></a> identified male gender and physical stress as predictors of in-hospital mortality. Beyond these factors, it has been demonstrated that in-hospital mortality is associated with underlying serious illness such as sepsis, acute renal injury, respiratory failure and cancer.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">15,42</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Prognosis in follow-up</span><p id="par0370" class="elsevierStylePara elsevierViewall">The medium and long-term prognosis of TTS patients is described as favorable, with rapid and complete recovery of LV systolic function.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">7,19,44</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">Patients in our study had a good prognosis at the mean follow-up of 33±33 months, with all-cause mortality of 4.4%. Other studies, with different follow-up times, reported all-cause mortality between 2.9% and 24.7%.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13,16,17,22,43,45–47</span></a> In our study, most deaths were from non-cardiac causes (3.5% of the sample). Other series have also shown that medium- and long-term mortality of TTS patients is more often due to non-cardiac causes than to the syndrome itself. Thus, comorbidities significantly affect the prognosis of these patients.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13,40,45</span></a></p><p id="par0380" class="elsevierStylePara elsevierViewall">The recurrence rate of TTS was 4.4%. Other series have reported rates between 0% and 11.4%.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6,13,14,16,17,23,47</span></a> Elesber et al.,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">17</span></a> in a study of 100 patients with TTS, observed recurrence in 11.4% at four years of follow-up. Lower rates are reported by series with shorter follow-up.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13,14,23</span></a></p><p id="par0385" class="elsevierStylePara elsevierViewall">Regarding cardiovascular and cerebrovascular events, in our study 3.1% of patients had stroke/TIA and 0.4% had myocardial infarction. In Templin et al.,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a> the rate of major cardiovascular and cerebrovascular events was 9.9%/year and the rate of stroke/TIA was 1.7%/year.</p><p id="par0390" class="elsevierStylePara elsevierViewall">The observed variability in mortality and clinical complications is related to the number of patients included and the follow-up times in the different series.</p><p id="par0395" class="elsevierStylePara elsevierViewall">In our study, prolonged QTc on admission was associated with events in follow-up (p=0.001). Some studies have observed an association between TTS and prolonged QTc, but there is little evidence on its prognostic impact.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">26,28,43</span></a></p><p id="par0400" class="elsevierStylePara elsevierViewall">Song et al.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">43</span></a> found that patients with long QTc presented a higher prevalence of cardiogenic shock and ventricular arrhythmias and lower LVEF compared to the group with normal QT interval. Similarly, Imran et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">28</span></a> demonstrated that prolonged QTc was associated with in-hospital clinical complications.</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Limitations</span><p id="par0405" class="elsevierStylePara elsevierViewall">Certain limitations should be borne in mind when assessing our results. This was a retrospective observational study and as such is subject to inherent bias. However, it is a multicenter study with a significant number of patients. The small number of events at follow-up meant it was not possible to identify predictors of medium-term prognosis or of in-hospital and follow-up mortality. In this study, treatment administered on admission and during follow-up was not analyzed, which is a limitation. The centers participating in the study did not routinely use laboratory hormone tests or imaging to exclude pheochromocytoma or myocarditis. The degree of coronary stenosis was not assessed by fractional flow reserve, nor were atherosclerotic plaques characterized by intravascular ultrasound or optical coherence tomography.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusion</span><p id="par0410" class="elsevierStylePara elsevierViewall">Our study confirms the low mortality associated with TTS. However, the high rate of in-hospital complications shows that TTS is not as benign as previously described. In our study, CKD, clinical presentation with dyspnea, CAD and lower LVEF on admission were predictors of in-hospital clinical complications.</p><p id="par0415" class="elsevierStylePara elsevierViewall">In the medium term, TTS has a good prognosis, with low rates of mortality, stroke and recurrence. Mortality at follow-up is predominantly due to non-cardiac causes. Prolonged QTc on admission was associated with complications at follow-up.</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0420" class="elsevierStylePara elsevierViewall">SUNSHINE is supported by BIAL, MSD, Shire, Pfizer, BMS and Trigenius.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1269348" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1174864" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1269347" "titulo" => "Resumo" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1174863" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Baseline characteristics of the study population" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical complications during hospitalization" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Clinical complications during follow-up" ] ] ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Discussion" "secciones" => array:11 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Clinical presentation" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Electrocardiogram" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Biomarkers of myocardial necrosis" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Left ventricular ejection fraction" ] 5 => array:2 [ "identificador" => "sec0080" "titulo" => "Classification of Takotsubo syndrome" ] 6 => array:2 [ "identificador" => "sec0085" "titulo" => "Coronary artery disease" ] 7 => array:2 [ "identificador" => "sec0090" "titulo" => "Clinical complications during hospitalization" ] 8 => array:2 [ "identificador" => "sec0095" "titulo" => "Predictors of in-hospital clinical complications" ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "In-hospital mortality" ] 10 => array:2 [ "identificador" => "sec0105" "titulo" => "Prognosis in follow-up" ] ] ] 8 => array:2 [ "identificador" => "sec0110" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0115" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0120" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack435593" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-03" "fechaAceptado" => "2018-07-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1174864" "palabras" => array:5 [ 0 => "Takotsubo syndrome" 1 => "Complications" 2 => "Mortality" 3 => "Prognosis" 4 => "Follow-up" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1174863" "palabras" => array:5 [ 0 => "Síndrome de Takotsubo" 1 => "Complicações" 2 => "Prognóstico" 3 => "Mortalidade" 4 => "<span class="elsevierStyleItalic">Follow-up</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) systolic dysfunction.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To characterize a Portuguese population with TTS and to determine their short- and medium-term prognosis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a multicenter study in Portuguese hospitals that included all patients diagnosed with TTS, initially retrospectively and subsequently prospectively. Short- and medium-term clinical complications and mortality were assessed. Independent predictors of in-hospital complications and prognostic factors were determined.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 234 patients (210 female, age 68±12 years) were included. During hospitalization, 32.9% of patients had complications: acute heart failure (24.4%), atrial fibrillation (9.0%), ventricular arrhythmias (2.6%), complete atrioventricular block (2.1%), stroke/transient ischemic attack (1.7%), and LV thrombus (1.3%).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chronic kidney disease (CKD) (p=0.02), coronary artery disease (CAD) (p=0.027), lower LV ejection fraction (LVEF) on admission (p=0.003), and dyspnea at presentation (p=0.019) were predictors of in-hospital complications. In-hospital mortality was 2.2%. At the mean follow-up of 33±33 months, all-cause mortality was 4.4%, cardiovascular mortality was 0.9% and TTS recurrence was 4.4%. Prolonged QTc interval on admission was associated with complications in follow-up (p=0.001).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">TTS has a good short- and medium-term prognosis. However, the rate of in-hospital complications is high and should not be overlooked. Dyspnea at presentation, CKD, CAD and lower LVEF on admission were independent predictors of in-hospital complications. Prolonged QTc on admission was associated with complications in follow-up.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introdução</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A síndrome de Takotsubo (TTS) caracteriza-se por disfunção sistólica ventricular esquerda transitória.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Caracterizar uma população portuguesa com TTS e determinar o seu prognóstico a curto e médio prazo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudo multicêntrico português com inclusão retrospetiva e prospetiva de todos os doentes diagnosticados com TTS. Foram avaliadas as complicações clínicas e a mortalidade a curto e médio prazo. Determinaram-se os preditores independentes de complicações intra-hospitalares e os fatores associados ao prognóstico.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 234 doentes (210 mulheres, 68±12 anos). Durante o internamento, 32,9% dos doentes apresentaram complicações clínicas: insuficiência cardíaca (24,4%), fibrilhação auricular (9,0%), arritmias ventriculares (2,6%), bloqueio auriculoventricular completo (2,1%), acidente vascular cerebral/acidente isquémico transitório (1,7%) e trombo no ventrículo esquerdo (1,3%). Doença renal crónica (DRC) (p=0,02), apresentação com dispneia (p=0,019), presença de doença arterial coronária (DAC) (p=0,027) e menor fração de ejeção ventricular esquerda (FEVE) na admissão (p=0,003) foram preditores independentes de complicações intra-hospitalares. A taxa de mortalidade intra-hospitalar foi de 2,2%. No <span class="elsevierStyleItalic">follow-up</span> médio de 33± 33 meses, a taxa de mortalidade global foi de 4,4%, 0,9% de causa cardíaca. A taxa de recorrência de TTS foi 4,4%. O prolongamento do intervalo QTc na admissão associou-se a complicações clínicas no <span class="elsevierStyleItalic">follow-up</span> (p=0,001).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusão</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A TTS tem bom prognóstico a curto e a médio prazo. Contudo, a taxa de complicações intra-hospitalares é elevada e não deve ser menosprezada. A DRC, apresentação como dispneia, DAC concomitante e menor FEVE na admissão são preditores de complicações intra-hospitalares. O prolongamento do intervalo QTc na admissão associou-se a complicações no <span class="elsevierStyleItalic">follow-up</span>.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVOT: left ventricular outflow tract; MI: myocardial infarction; QTc: corrected QT interval; TTE: transthoracic echocardiogram.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Information presented as mean ± standard deviation or n (%).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Demographic data</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68±12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">210 (89.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women aged over 50 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">192 (91.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postmenopausal women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168 (80.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Cardiovascular risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (67.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">127 (54.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (14.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Personal history</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Valvular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Triggering factor</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">152 (65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emotional stress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical stress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Clinical presentation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chest pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">204 (87.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Syncope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Killip class ≥2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Electrocardiogram</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sinus rhythm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">216 (92.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative T waves \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (40.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ST-segment elevation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pathological Q waves \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prolonged QTc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ST-segment depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LBBB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Elevated troponin</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">208 (89.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">No significant CAD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">195 (87.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">TTE</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVEF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43±11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Significant (grade 3-4) mitral regurgitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVOT obstruction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Apical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">182 (77.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Midventricular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Focal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Hospital stay, days</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6±5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171201.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients with Takotsubo syndrome (n=234).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AV: atrioventricular; LV: left ventricular; TIA: transient ischemic attack; VF ventricular fibrillation; VT: ventricular tachycardia.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Information presented as n (%).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Clinical complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (32.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 (24.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>New-onset atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VT/VF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Complete AV block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stroke/TIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LV thrombus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Interventions</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inotropic support \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Temporary pacemaker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171204.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical complications and interventions during hospitalization (n=234).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; CKD: chronic kidney disease; LVEF: left ventricular ejection fraction; OR: odds ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unadjusted OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">History of heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.4 (1.96-20.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical stress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.036 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 (1.04-4.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27 (0.12-0.60) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 (2.67-9.99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atherosclerotic coronary lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 (1.21-5.87) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF on admission, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46±10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38±10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(3.98-11.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171200.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Variables associated with clinical complications during hospitalization.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; CKD: chronic kidney disease; LVEF: left ventricular ejection fraction; OR: odds ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.99 (1.39-45.79) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.82 (1.25-11.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atherosclerotic coronary lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.87 (1.17- 12.76) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF on admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.93 (0.89-0.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171202.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Predictors of in-hospital clinical complications.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">TIA: transient ischemic attack; TTS: Takotsubo syndrome.</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Information presented as n (%).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All-cause mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-cardiovascular mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TTS recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke/TIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myocardial infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171205.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Clinical complications at follow-up (n=229).</p>" ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; OR: odds ratio; QTc: corrected QT interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">No clinical complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Clinical complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Unadjusted OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prolonged QTc on admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6 (1.76-12.15) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171203.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Variables associated with clinical complications at follow-up.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib0240" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo-type cardiomyopathy due to multivessel spasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Sato" 1 => "H. Tateishi" 2 => "T. Uchida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "K.Kodama, K.Haze, M.Hon" "titulo" => "Clinical aspect of myocardial injury: from ischemia to heart failure" "paginaInicial" => "56" "paginaFinal" => "64" "serieFecha" => "1990" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0245" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gianni" 1 => "F. Dentali" 2 => "A.M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 10 | 4 | 14 |
| 2024 Outubro | 52 | 28 | 80 |
| 2024 Setembro | 74 | 24 | 98 |
| 2024 Agosto | 228 | 44 | 272 |
| 2024 Julho | 56 | 28 | 84 |
| 2024 Junho | 59 | 36 | 95 |
| 2024 Maio | 48 | 26 | 74 |
| 2024 Abril | 50 | 35 | 85 |
| 2024 Maro | 57 | 27 | 84 |
| 2024 Fevereiro | 39 | 14 | 53 |
| 2024 Janeiro | 46 | 34 | 80 |
| 2023 Dezembro | 76 | 36 | 112 |
| 2023 Novembro | 70 | 33 | 103 |
| 2023 Outubro | 38 | 17 | 55 |
| 2023 Setembro | 39 | 24 | 63 |
| 2023 Agosto | 44 | 15 | 59 |
| 2023 Julho | 56 | 18 | 74 |
| 2023 Junho | 38 | 14 | 52 |
| 2023 Maio | 97 | 37 | 134 |
| 2023 Abril | 53 | 9 | 62 |
| 2023 Maro | 63 | 26 | 89 |
| 2023 Fevereiro | 39 | 17 | 56 |
| 2023 Janeiro | 27 | 18 | 45 |
| 2022 Dezembro | 61 | 30 | 91 |
| 2022 Novembro | 52 | 39 | 91 |
| 2022 Outubro | 71 | 39 | 110 |
| 2022 Setembro | 43 | 44 | 87 |
| 2022 Agosto | 35 | 31 | 66 |
| 2022 Julho | 44 | 50 | 94 |
| 2022 Junho | 40 | 28 | 68 |
| 2022 Maio | 29 | 38 | 67 |
| 2022 Abril | 43 | 46 | 89 |
| 2022 Maro | 62 | 47 | 109 |
| 2022 Fevereiro | 42 | 42 | 84 |
| 2022 Janeiro | 38 | 38 | 76 |
| 2021 Dezembro | 30 | 34 | 64 |
| 2021 Novembro | 33 | 43 | 76 |
| 2021 Outubro | 31 | 37 | 68 |
| 2021 Setembro | 37 | 37 | 74 |
| 2021 Agosto | 28 | 34 | 62 |
| 2021 Julho | 27 | 27 | 54 |
| 2021 Junho | 50 | 29 | 79 |
| 2021 Maio | 42 | 26 | 68 |
| 2021 Abril | 74 | 56 | 130 |
| 2021 Maro | 58 | 33 | 91 |
| 2021 Fevereiro | 38 | 17 | 55 |
| 2021 Janeiro | 36 | 12 | 48 |
| 2020 Dezembro | 54 | 11 | 65 |
| 2020 Novembro | 29 | 14 | 43 |
| 2020 Outubro | 38 | 16 | 54 |
| 2020 Setembro | 52 | 18 | 70 |
| 2020 Agosto | 25 | 17 | 42 |
| 2020 Julho | 55 | 12 | 67 |
| 2020 Junho | 25 | 13 | 38 |
| 2020 Maio | 51 | 14 | 65 |
| 2020 Abril | 48 | 24 | 72 |
| 2020 Maro | 38 | 15 | 53 |
| 2020 Fevereiro | 86 | 29 | 115 |
| 2020 Janeiro | 30 | 18 | 48 |
| 2019 Dezembro | 46 | 13 | 59 |
| 2019 Novembro | 37 | 10 | 47 |
| 2019 Outubro | 52 | 18 | 70 |
| 2019 Setembro | 127 | 27 | 154 |
| 2019 Agosto | 25 | 26 | 51 |
| 2019 Julho | 86 | 47 | 133 |
| 2019 Junho | 49 | 37 | 86 |
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