Prevalence of hepatitis C virus infection in patients with cardiomyopathy
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Ann Hepatol. 2009;8:103-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 73 "formatos" => array:3 [ "EPUB" => 21 "HTML" => 26 "PDF" => 26 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Current and future treatment options for HCV" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "112" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bernd Kronenberger, Stefan Zeuzem" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Bernd" "apellidos" => "Kronenberger" ] 1 => array:2 [ "nombre" => "Stefan" "apellidos" => "Zeuzem" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119317867?idApp=UINPBA00004N" "url" => "/16652681/0000000800000002/v1_201906260852/S1665268119317867/v1_201906260852/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "titulo" => "Prevalence of hepatitis C virus infection in patients with cardiomyopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vijaya Boyella;, Ikenna Onyebueke;, Najabh Farraj;, Suzette Graham-Hill;, Cherif El Younis;, Nora V. Bergasa" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Vijaya" "apellidos" => "Boyella;" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "Ikenna" "apellidos" => "Onyebueke;" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Najabh" "apellidos" => "Farraj;" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Suzette" "apellidos" => "Graham-Hill;" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Cherif" "apellidos" => "El Younis;" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "Nora V." "apellidos" => "Bergasa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff3" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Kings County Hospital Center" "etiqueta" => "1" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Brookdale University Hospital, Brooklyn" "etiqueta" => "2" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Department of Medicine, Metropolitan Hospital Center, New York, New York." "etiqueta" => "3" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Address for correspondence:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">No conflict of interests exist</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Investigator initiated study supported by Roche Pharmaceuticals.</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0010" class="elsevierStylePara elsevierViewall">Chronic hepatitis C can be associated with extrahepatic manifestations including cryoglobulinemia, lymphoma, thyroiditis, and membranoproliferative glomerulonephritis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1</span></a>-<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> An association between chronic hepatitis C and cardiomyopathies has also been reported.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6</span></a>-<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Myocarditis is an inflammation of the myocardium that can be caused by several cardiotropic viruses and that can lead to dilated cardiomyopathy and heart failure.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11</span></a>-<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> A high prevalence of hepatitis C virus infection has been reported in patients from Japan with hypertrophic cardiomyopathy, dilated cardiomyopathy and myocarditis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8</span></a>-<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14</span></a>-<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Recently, the case of a patient with cardiomyopathy and chronic hepatitis C in whom the treatment of the viral hepatitis had been associated with disappearance of the hepatitis C virus from serum and the resolution of his symptoms of heart failure was reported.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> According, to explore further this association, we studied the prevalence of chronic hepatitis C in a group of patients with dilated cardiomyopathy from the United States.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="p0020" class="elsevierStylePara elsevierViewall">This was a prospective study of patients with ischemic and non-ischemic cardiomyopathy who were being followed at the cardiology clinic of a tertiary public hospital in Central Brooklyn. Cardiomyopathy was defined as an ejection fraction of less than 40% as evaluated by a transthoracic echocardiogram. All the patients signed an informed consent prior to participating in the study. The study period was from December 2006 to March 2007.</p><p id="p0025" class="elsevierStylePara elsevierViewall">Serum samples were sent to a commercial laboratory for determination of hepatitis C antibody by an enzyme linked immunosorbent assay and for quantitation of hepatitis C viral RNA by the COBAS Taqman real time by PCR methodology.</p><p id="p0030" class="elsevierStylePara elsevierViewall">The study was approved by the Institutional Review Board.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="p0035" class="elsevierStylePara elsevierViewall">Sixty-three patients were recruited. The study group was comprised of 41 patients with non ischemic and 22 patients with ischemic cardiomyopathy.</p><p id="p0040" class="elsevierStylePara elsevierViewall">The median age was 61.4 years (range 32 to 85) in the patients with ischemic cardiomyopathy, and 51 (range 32 to 85) in the group with non-ischemic cardiomyopathy. There were nineteen women and 23 men in the group of patients with non-ischemic cardiomyopathy, and five women and seventeen men in the group of patients with ischemic cardiomyopathy (<a class="elsevierStyleCrossRef" href="#t0005">Table I</a>).</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0045" class="elsevierStylePara elsevierViewall">The diagnosis of cardiomyopathy had been made by a transthoracic echocardiogram showing findings of muscular dysfunction consistent with the different patterns of cardiomyopathy. The median ejection fraction in the patients with non-ischemic dilated cardiomyopathy was 25% (range 10 to 40); four patients in this group had features consistent with hypertrophic cardiomyopathy. The median ejection fraction of the group of patients with ischemic cardiomyopathy was 30% (10 to 40). Thirty nine of the 41 patients with non-ischemic cardiomyopathy had had a cardiac catheterization, which had been normal in all. All the patients with ischemic cardiomyopathy had had an abnormal cardiac catheterization revealing vessel disease (<a class="elsevierStyleCrossRef" href="#t0010">Table II</a>).</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">None of the patients had evidence of acute viral hepatitis based on the hepatic profile available at the time of serum collection. Of the 41 patients with non-ischemic cardiomyopathy, two (4.8%) had serum antibodies to the hepatitis C virus and one of those had hepatitis C RNA (2.4%) in serum, consistent with chronic hepatitis C. In the ischemic cardiomyopathy group, one of the 22 patients (4.5%) had serum antibodies to the hepatitis C virus but the hepatitis C RNA was not detected in their serum, consistent with prior infection and resolution of the hepatitis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="p0055" class="elsevierStylePara elsevierViewall">In this study, the prevalence of chronic hepatitis C, defined by positive hepatitis C virus RNA in serum in patients with ischemic cardiomyopathy was 0%, and in patients with non-ischemic cardiomyopathy it was 2.4%. This prevalence is not much higher than the reported for the US population, not suggesting an association between non-ischemic cardiomyopathy and chronic hepatitis C. This finding is in contrast with the reports from Japan, in which a 16% prevalence of chronic hepatitis C in patients with non-ischemic cardiomyopathy was reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="p0060" class="elsevierStylePara elsevierViewall">The association between chronic hepatitis C in various types of cardiomyopathy was originally reported in Japan, from where most of the literature in this subject has emerged. A study conducted in Italy reported a prevalence of hepatitis C antibodies in patients with cardiomyopathy to be 3.9%,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> which was not significantly different from that of patients without dilated cardiomyopathy. A study from Brazil reported a prevalence of hepatitis C carrier state of 2.9%,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> similar to our results, not suggesting an association between the two conditions. A publication that reported a literature review on the publications that had revealed an association between dilated cardiomyopathy and chronic hepatitis C stated that a significant association between dilated cardiomyopathy and hepatitis C virus had been found in only two papers, both from Japan and by the same author.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> On the surface, the data published so far, including our paper, do not support an association between chronic hepatitis C virus infection and dilated cardiomyopathy; however, the patient we reported<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> had such a dramatic response to the treatment of his chronic hepatitis C, which was associated with documented improvement of his ejection fraction and disappearance of symptoms of cardiomyopathy, that the potential for this association cannot be ignored as the option to treat with antiviral therapy exists. An association between hepatitis C and cardiomyopathy was also supported another case report from the United States.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">A limitation of this study is that the only test collected prospectively was the blood sample for antibody and hepatitis C virus RNA determination; all other information was collected retrospectively from the medical records. The review of the data, however, did not suggest that the patients with HCV RNA in serum had acute hepatitis C; thus, it is very likely that the patient who had hepatitis C RNA in serum had chronic hepatitis C.</p><p id="p0070" class="elsevierStylePara elsevierViewall">Dilated and hypertrophic cardiomyopathies in patients with chronic hepatitis C were reported to be more prevalent in subjects who had HLA-DPB1<span class="elsevierStyleSup">*</span>0901 and HLA-DRB1<span class="elsevierStyleSup">*</span>1201.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> A Non-HLA gene locus spanning from the NFKBIL1 to the MICA gene loci within the MHC class III-class I boundary region was also reported to be characteristic in patients with dilated cardiomyopathy associated with chronic hepatitis C.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The majority of the patients studied in our study were black, either from the United States or from the Caribbean Islands, consistent with the population of central Brooklyn; accordingly, it is very likely that the HLA make up of these patients was different from that of the patients from Japan in whom a significant prevalence of chronic hepatitis C has been reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="p0075" class="elsevierStylePara elsevierViewall">Patients with chronic hepatitis C and cardiomyopathy tend to be excluded from the treatment of the hepatitis because the cardiac comorbidities increase their vulnerability to serious consequences from the side effects of the medications (e.g. from the anemia). On the other hand, if the hepatitis C virus infection is the cause of the cardiomyopathy, treating the hepatitis with antiviral medications offers the opportunity to eliminate the virus, and for the recovery of cardiac function in association with the treatment, as exemplified in a previously reported case.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> As treatment of chronic hepatitis C can deter the progression of liver disease, and it may also treat the cardiomyopathy, which is associated with an increased risk of cardiovascular and all mortality,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> it is important to determine if indeed, cardiomyopathy is one of the extrahepatic manifestations of chronic hepatitis C. Thus, studies that explore this association in different ethnic and racial groups properly powered to detect difference in prevalence are warranted.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "xres1211988" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1128058" "titulo" => "Key words" ] 2 => array:3 [ "identificador" => "sec0005" "titulo" => "Investigator initiated study supported by Roche Pharmaceuticals." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] ] ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-02-25" "fechaAceptado" => "2009-03-09" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1128058" "palabras" => array:4 [ 0 => "Hepatitis C," 1 => "cardiomyopathy," 2 => "extrahepatic manifestation," 3 => "HLA system." ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abs0005" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Chronic hepatitis C can be associated with extrahepatic manifestations; thus, we explored the association of this viral infection with dilated cardiomyopathy in a group of sixty-three patients with a cardiac ejection fraction of less than 40% determined by an echocardiogram in a prospective study. Two of the forty-one patients with non-ischemic cardiomyopathy (4.8%) had serum antibodies to the hepatitis C virus and one of those had hepatitis C virus RNA (2.4%) in serum, consistent with chronic hepatitis C. One of the 22 patients with ischemic cardiomyopathy (4.5%) had serum antibodies to the hepatitis C virus but the hepatitis C virus RNA was not detected in their serum, consistent with prior infection but not chronic hepatitis C. In this study, chronic hepatitis C was not prevalent in the group of patients, although the only patient with chronic hepatitis C had non-is-chemic cardiomyopathy. As a genetic predisposition to develop cardiomyopathy secondary to chronic hepatitis C has been suggested to be relevant in this type of complication, studies that include different racial and ethnic groups are warranted, as treatment of the hepatitis may lead to resolution of the cardiomyopathy.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "t0005" "etiqueta" => "<span class="elsevierStyleBold">Table I.</span>" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">Parameter \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="top" scope="col">Non ischemic cardiomyopathy \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="top" scope="col">Ischemic cardiomyopathy \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" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Total number of patients \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="middle">41 \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="middle">22 \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 " align="left" valign="top">Age (years) (median) \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="middle">51.1 (range 32-85) \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="middle">61.4 (range 34-92) \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 " align="left" valign="top">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="middle"> \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="middle"> \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 " align="left" valign="top">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="middle">19 \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="middle">5 \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 " align="left" valign="top">Men \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="middle">22 \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="middle">17 \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 " align="left" valign="top">Risk factors for hepatitis C \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="middle"> \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="middle"> \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 " align="left" valign="top">virus infection \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="middle"> \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="middle"> \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 " align="left" valign="top">Substance abuse \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="middle">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="middle">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2069095.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients included in the study.</p>" ] ] 1 => array:7 [ "identificador" => "t0010" "etiqueta" => "<span class="elsevierStyleBold">Table II.</span>" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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="left" valign="top" 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="top" scope="col">Ejection fraction (%) Median (range) \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="top" scope="col">Abnormal cardiac catheterization N (%) \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" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Non-ischemic cardiomyopathy \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="top">25 (10-40) \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="middle">0/39<a class="elsevierStyleCrossRef" href="#tabltfn0005"><span class="elsevierStyleSup">*</span></a> \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 " align="left" valign="top">(Number of patients: 41) \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="middle"> \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="middle">(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 " align="left" valign="top">Ischemic cardiomyopathy \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="middle">30 (10-40%) \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="middle">20/20 \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 " align="left" valign="top">(Number of patients: 22) \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="middle"> \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="middle">(100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2069096.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tabltfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npara0005">39 of the 41 patients had a cardiac catheterization</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Ejection fraction and cardiac catheterization results in the study group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 9 | 4 | 13 |
| 2024 September | 9 | 3 | 12 |
| 2024 August | 6 | 0 | 6 |
| 2024 July | 5 | 6 | 11 |
| 2024 June | 3 | 2 | 5 |
| 2024 May | 4 | 1 | 5 |
| 2024 April | 11 | 3 | 14 |
| 2024 March | 13 | 6 | 19 |
| 2024 February | 8 | 5 | 13 |
| 2024 January | 7 | 5 | 12 |
| 2023 December | 3 | 4 | 7 |
| 2023 November | 8 | 2 | 10 |
| 2023 October | 10 | 7 | 17 |
| 2023 September | 4 | 1 | 5 |
| 2023 August | 6 | 3 | 9 |
| 2023 July | 9 | 7 | 16 |
| 2023 June | 1 | 2 | 3 |
| 2023 May | 8 | 4 | 12 |
| 2023 April | 3 | 0 | 3 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 4 | 6 | 10 |
| 2023 January | 3 | 12 | 15 |
| 2022 December | 6 | 2 | 8 |
| 2022 November | 9 | 11 | 20 |
| 2022 October | 7 | 5 | 12 |
| 2022 September | 8 | 4 | 12 |
| 2022 August | 10 | 6 | 16 |
| 2022 July | 10 | 8 | 18 |
| 2022 June | 7 | 8 | 15 |
| 2022 May | 15 | 7 | 22 |
| 2022 April | 10 | 8 | 18 |
| 2022 March | 18 | 6 | 24 |
| 2022 February | 11 | 5 | 16 |
| 2022 January | 23 | 4 | 27 |
| 2021 December | 12 | 11 | 23 |
| 2021 November | 11 | 7 | 18 |
| 2021 October | 8 | 6 | 14 |
| 2021 September | 4 | 7 | 11 |
| 2021 August | 6 | 6 | 12 |
| 2021 July | 12 | 6 | 18 |
| 2021 June | 4 | 7 | 11 |
| 2021 May | 8 | 8 | 16 |
| 2021 April | 27 | 13 | 40 |
| 2021 March | 8 | 5 | 13 |
| 2021 February | 8 | 7 | 15 |
| 2021 January | 11 | 8 | 19 |
| 2020 December | 2 | 4 | 6 |
| 2020 November | 10 | 4 | 14 |
| 2020 October | 7 | 4 | 11 |
| 2020 September | 16 | 11 | 27 |
| 2020 August | 9 | 5 | 14 |
| 2020 July | 5 | 0 | 5 |
| 2020 June | 2 | 1 | 3 |
| 2020 May | 3 | 6 | 9 |
| 2020 April | 1 | 1 | 2 |
| 2020 March | 3 | 3 | 6 |
| 2020 February | 5 | 7 | 12 |
| 2020 January | 3 | 2 | 5 |
| 2019 December | 3 | 2 | 5 |
| 2019 November | 11 | 7 | 18 |
| 2019 October | 1 | 0 | 1 |
| 2019 September | 1 | 0 | 1 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 4 | 7 | 11 |
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