Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease

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ATTR: amiloidosis por transtirretina; CHTA: cardiopatía hipertensiva; IC: insuficiencia cardiaca." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Gallo-Fernández, José López-Aguilera, Rafael González-Manzanares, Cristina Pericet-Rodriguez, Manuel Jesús Carmona-Rico, Jorge Perea-Armijo, Juan Carlos Castillo-Domínguez, Manuel Anguita-Sánchez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Gallo-Fernández" ] 1 => array:2 [ "nombre" => "José" "apellidos" => "López-Aguilera" ] 2 => array:2 [ "nombre" => "Rafael" "apellidos" => "González-Manzanares" ] 3 => array:2 [ "nombre" => "Cristina" "apellidos" => "Pericet-Rodriguez" ] 4 => array:2 [ "nombre" => "Manuel Jesús" "apellidos" => "Carmona-Rico" ] 5 => array:2 [ "nombre" => "Jorge" "apellidos" => "Perea-Armijo" ] 6 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Castillo-Domínguez" ] 7 => array:2 [ "nombre" => "Manuel" "apellidos" => "Anguita-Sánchez" ] 8 => array:1 [ "colaborador" => "en representación del Grupo de Trabajo de Insuficiencia Cardiaca del Hospital Reina Sofía" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624000457" "doi" => "10.1016/j.medcle.2023.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000457?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006073?idApp=UINPBA00004N" "url" => "/00257753/0000016200000005/v1_202402251117/S0025775323006073/v1_202402251117/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020624000469" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.10.012" "estado" => "S300" "fechaPublicacion" => "2024-03-08" "aid" => "6451" "copyright" => "Elsevier España, S.L.U." 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HF: heart failure." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Luis Bonilla-Palomas, Manuel Anguita-Sánchez, Cristina Fernández-Pérez, José Luis Bernal-Sobrino, María García, Náyade Prado, Nicolás Rosillo, Julián Pérez-Villacastín, Juan José Gómez-Doblas, Francisco Javier Elola-Somoza" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Juan Luis" "apellidos" => "Bonilla-Palomas" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Anguita-Sánchez" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Fernández-Pérez" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "Bernal-Sobrino" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "García" ] 5 => array:2 [ "nombre" => "Náyade" "apellidos" => "Prado" ] 6 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Rosillo" ] 7 => array:2 [ "nombre" => "Julián" "apellidos" => "Pérez-Villacastín" ] 8 => array:2 [ "nombre" => "Juan José" "apellidos" => "Gómez-Doblas" ] 9 => array:2 [ "nombre" => "Francisco 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"identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Manuel" "apellidos" => "Anguita-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 8 => array:2 [ "colaborador" => "on behalf of the members of the Heart Failure Working Group of the Reina Sofía Hospital" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Biomédica de Córdoba, IMIBIC, Cordoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de Córdoba, Cordoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1506 "Ancho" => 2159 "Tamanyo" => 187271 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve of time to all-cause death in patients with ATTR vs HHD. ATTR: t cardiac transthyretin amyloidosis; HHD: hypertensive heart disease." ] ] ] "textoCompleto" => "IntroductionHeart failure with preserved ejection fraction (HFpEF) is an entity on the increase in our environment, probably due to the ageing of the population and the increase of risk factors such as obesity, diabetes mellitus or arterial hypertension. It is the outcome of many diseases affecting the heart, including valvular heart disease, hypertensive heart disease, ischaemic heart disease, pericardial disease and infiltrative diseases such as cardiac amyloidosis.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a>One of the main causes of HFpEF is hypertensive heart disease (HHD),<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and it has been documented that in up to 13% of patients with HFpEF, if the aetiological study is performed correctly, the final diagnosis would be ATTR.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Given that HHD and cardiac transthyretin amyloidosis (ATTR) are 2 common aetiologies in HFpEF, and that many final diagnoses of ATTR are misdiagnoses of HHD, it is appropriate to investigate whether they have differential characteristics or whether there is a different prognostic evolution between the two causes of HFpEF.Thus, the objective of this study was to describe the clinical, electrocardiographic and echocardiographic characteristics of patients with ATTR and HHD. We also studied the prognostic evolution of both heart diseases in terms of all-cause mortality, hospital admissions due to heart failure, the need for a pacemaker (PPM), and time until the first episode of atrial fibrillation (AF).Material and methodsType of studyAn observational, retrospective, longitudinal and analytical study was conducted at the Reina Sofia University Hospital of Cordoba (HURS) from January 2016 to December 2021.PatientsThe study included patients from the outpatients clinic as well as patients discharged after hospital admission for heart failure (HF). The diagnosis of ATTR or HHD was made according to the following criteria:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Patients diagnosed with ATTR<a class="elsevierStyleCrossRef" href="#bib0030">6</a>: those with Perugrini grade 2 or 3 cardiac uptake in the 99mTc-Diphosphonates (DPD scintigraphy), and in whom there was no evidence of monoclonal gammopathy (absence of paraprotein in blood, kappa and lambda light chains in serum and urine immunofixation, and a normal kappa/lambda ratio). Genetic studies were carried out on all patients. Patients with a final diagnosis of cardiac amyloidosis other than ATTR were excluded from the analysis.</li><li class="elsevierStyleListItem" id="lsti0010">•Patients with a diagnosis of HHD: patients with long-standing HF, LVH and HT, whose hypertrophy could not be justified by any other cause.</li></ul>Clinical and laboratory variablesData related to the final aetiological diagnosis (HHD/ATTR), age at diagnosis (years), sex, creatinine level (mg/dl), hs-Tnl level (ng/l) and NT-proBNP level (pg/mL) at diagnosis were analysed.Electrocardiographic variablesBaseline electrocardiogram data were analysed for: rhythm at diagnosis (sinus rhythm or atrial fibrillation), presence of a pseudoinfarction pattern,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> low voltage pattern,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> AV block of any type, complete left bundle branch block, complete right bundle branch block, or the need for cardiac pacing by a PPM at the time of diagnosis. The presence of conduction disturbances was defined according to the American Heart Association diagnostic criteria for standardisation and interpretation of the surface electrocardiogram.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Echocardiographic variablesData from the transthoracic echocardiogram (TTE) baseline evaluation, at the time of diagnosis, were analysed. Variables of interest were: LVEF (%), determined by Teicholz or Simpson method; interventricular septum (IVS) thickness (mm), dilated atrium (Yes/No), mean E/e' value (absolute number), presence of pericardial effusion (Yes/No) and speckle pattern (Yes/No).Outcome variablesPrognosis was evaluated by the development of all-cause mortality, hospital admissions for heart failure, need for a PPM, and time until the first episode of atrial fibrillation.Statistical studyA descriptive study of the qualitative variables was carried out, calculating absolute and relative frequencies. The descriptive study of the quantitative variables calculated the arithmetic mean and standard deviation when these variables followed a normal distribution, using the Shapiro-Wilk test. When the quantitative variables did not follow a normal distribution, the median and interquartile range (IQR) were calculated. The 95% confidence interval was estimated for safety.A bivariate analysis compared the data collected for the variables between the ATTR and HHD groups, using appropriate parametric and non-parametric tests, depending on whether the data were normally distributed or not:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•To compare quantitative variables, a Student's t-test for independent data or the Mann–Whitney U-test was used, as appropriate.</li><li class="elsevierStyleListItem" id="lsti0020">•To compare nominal qualitative variables, the Chi-square statistic or Fisher's exact test was used as appropriate.</li></ul>Event-free survival (time to death from any cause, first admission for HF, need for a PPM and development of AF) was analysed using the Kaplan-Meier method and the two groups were compared using the log-rank test.All contrasts were bilateral and those where p was less than 0.05 were considered significant. Data were collected, processed and analysed with SPSS® statistical software version 26.Ethical considerationsThe study was approved by the Ethics Committee of the HURS, via the Andalusian Biomedical Research Ethics Portal (Code TFG-JLMM-2020, dated 09/12/2020).This project has followed the standards of good clinical practice and has been conducted in accordance with the principles set out in the Declaration of Helsinki. The data has been anonymised, respecting the confidentiality of the same, in accordance with Regulation (EU) 2016/679 of the European Parliament and Organic Law 3/2018 of 5 December on the Protection of Personal Data and guarantee of digital rights.ResultsClinical featuresThe study cohort included 72 patients with a previous diagnosis of HHD who had undergone a DPD scintigraphy study to screen for ATTR, and a light chain study to rule out amyloidosis (AL). Of these, 33 patients were finally diagnosed with ATTR (46%) and 39 patients had a final diagnosis of HHD (54%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The genetic study was positive in only 6 patients (18%) giving the diagnosis as hereditary ATTR (hATTR), and negative in 27 patients (82%) giving the diagnosis as wild-type ATTR (ATTRwt).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>No differences were found between the median age at diagnosis of the two groups (p = 0.058). The median age at diagnosis for the group diagnosed with ATTR was 80 years (IQR: 72.5−85.5) and for the group diagnosed with HHD it was 75 years (IQR: 68.5−80.5). The sex variable showed a higher frequency of males in the ATTR diagnosed group compared to the HHD diagnosed group (69.7 vs. 38.5%; p = 0.01) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The presence of AF (pre-study or developed during follow-up) was 78.8% in the ATTR group and 59% in the HHD group, with no statistically significant differences (p = 0.072). As for the need for a PPM, it was higher in ATTR patients (27.3%) compared to HHD patients (7.7%); p = 0.026 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Analytical resultsWith respect to blood test variables, statistically significant differences were detected between hs-Tnl and NT-proBNP levels in both groups, with higher levels in the ATTR group compared to patients diagnosed with HHD (double the hs-Tnl value, and up to four times higher in NT-proBNP value). However, there were no differences in creatinine levels in patients diagnosed with ATTR compared to patients with HHD (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Electrocardiographic parametersSome differences were found in the electrocardiographic parameters. The ATTR group showed a higher frequency of pseudoinfarction pattern (54.5 vs. 25.6%; p = 0.009), AV block of any type (48.4 vs. 15.4%; p = 0.005), conduction disturbances in general (63.6 vs. 31%; p = 0.007) and specifically LBBB (21.1 vs. 2.6%; p = 0.024). In contrast, no differences were found between the two groups regarding the presence of low voltage pattern (39 vs. 30.7%; p = 0.379) or for the presence of RBBB (6.1 vs. 7.7%; p = 0.799) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Echocardiographic dataDifferences were also found in the TTE variables: patients with ATTR had greater IVS thickness (median 16 mm [IQR of 14−19 mm] vs. median 14 mm [IQR of 12−16 mm], p = 0.001), higher mean E/e' value (mean 14.6 ± 5.4 vs. mean of 10.2 ± 4.3; p = 0.007) and higher presence of myocardial granular speckling (42.4 vs. 5.1%; p = 0.001). On the other hand, the presence of preserved LVEF was lower in the ATTR group (48.5%) than in the HHD group (97.4%); p = 0.001. No differences were found in the presence of dilated atrium (75.8 vs. 62.9%; p = 0.285) or pericardial effusion (9.1 vs. 15.4%; p = 0.489) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Prognosis: mortality, readmission for heart failure, need for pacemaker and development of atrial fibrillation.In the prognostic study, with a mean follow-up of 49.9 ± 42.2 months of patients with both nosological entities, patients with ATTR had a higher need for a PPM at follow-up (log-rank = 0.034) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). However, no statistically significant differences were found for all-cause mortality (log-rank = 0.06) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), time to development of AF (log-rank = 0.720) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) or admission for heart failure (log-rank = 0.650) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia>DiscussionATTR is a disease that is clearly underdiagnosed. It frequently remains hidden under other diagnostic entities (such as the aforementioned HHD, hypertrophic cardiomyopathy, ischaemic heart disease or aortic stenosis, among others), and only when sufficient clinical suspicion is established are the appropriate complementary tests requested for the diagnosis of this entity. However, the implementation of non-invasive diagnosis of ATTR, using a combination of DPD scintigraphy and an analytical study of light chains in urine, has led to an increase in the number of diagnosed cases of ATTR in recent years, in contrast to the data from years prior to this study protocol, when a histological study was the gold standard.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Despite this progress, there is evidence that this entity is still seriously under-diagnosed, supporting the need to accurately characterise it. For example, some studies report that up to 70% of patients obtained a definitive diagnosis of ATTR after having been assessed by 3 or more different specialists.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> A phenomenon to be taken into account as a result of the new diagnostic algorithm for this disease is the possibility of a false-negative DPD scintigraphy result in patients with ATTR, especially in hATTR associated with the Phe84Leu and Ser97Tyr mutation. Therefore, the prevalence in our population could be higher than that observed because no patient diagnosed with HHD underwent additional screening for CA.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Following along these lines, as already mentioned this algorithm avoids a histological study, and therefore could overlook the possibility of patients with 2 types of simultaneous cardiac amyloidosis, as has been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>One of the main differential diagnoses of ATTR is HHD, as both can present as HFpEF: they increase in prevalence with age, share symptoms (exertional dyspnoea, lower limb oedema, weakness, tachycardia, etc.) and have a high prevalence of AF. On the other hand, these entities present certain clinical differences: on a symptomatic level, the presence of chest pain is more frequent in HHD, while extracardiac manifestations such as carpal tunnel syndrome, peripheral neuropathy, lumbar spinal stenosis or even ocular disorders (glaucoma, myodesopsias, scalloped pupil) would be more suggestive of ATTR.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Other differences would be gender distribution (ATTR is more prevalent in men while HHD is more prevalent in women) and the need for a PPM (more common in ATTR than in HHD), as in the findings found in our series. The higher prevalence of ATTR in men than in women found in our cohort coincides with the evidence available to date on the prevalence of this disease.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Some authors suggest that this may be due to the protective effect of oestrogens in women, based on a study that showed that ATTR in women appears mainly after the menopause. Also, this disease may be underdiagnosed in females due to a more latent clinical presentation, as a retrospective study found that post-mortem diagnosis of ATTR was higher in females than in males (31 vs. 9%).<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Although no significant differences regarding age were found in our study, the HHD group tended to be younger than the ATTR group. The ATTR group being older could also have to do with the delay in the diagnostic process that has traditionally taken place in this disease. On the other hand, given that high blood pressure (HBP) usually begins at a much younger age, in principle it seems logical that patients with HHD are younger than those diagnosed with ATTR, and the reduced difference between the two groups could be due to the fact that therapeutic advances in the control of HBP allow a delay in the progression to heart disease.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Although we do not have age-adjusted prognostic results for the events studied, these would be interesting, when we consider the older age of patients with ATTR and the mean follow-up of 4 years.Our study also found a similar prevalence of AF in both entities. This result was to be expected given that the pathophysiological mechanism that triggers this arrhythmia in both populations is fundamentally the compensatory left atrial enlargement due to chronic elevated left atrial pressure,<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> although in our study we found no differences between the two groups in terms of the prevalence of left atrial enlargement. We also found no differences in the time required to develop atrial fibrillation in the evolution of both nosological entities (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).On the other hand, both entities often present as HFpEF, an increasingly prevalent clinical syndrome, accounting for up to 50% of all cases of HF in some series.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> HFpEF is a catch-all for diseases of very diverse origins such as HHD, ATTR, sarcoidosis, other infiltrative cardiomyopathies, hypertrophic cardiomyopathy, etc., with one aspect in common - the increase in the degree of hypertrophic cardiomyopathy. A multifactorial origin has been postulated for this increase, where the different cardiovascular risk factors (HBP, diabetes, ageing, obesity, chronic kidney disease, etc.,) contribute towards generating a state of low-grade systemic inflammation and neurohumoral activation (mainly through the renin-angiotensin-aldosterone axis). This would trigger ventricular hypertrophy as a compensatory mechanism in the short term, but would subsequently become disproportionate, ultimately triggering the clinical syndrome of heart failure.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>In terms of analytical parameters, it seems logical that patients with ATTR have higher levels of hs-Tnl and NT-ProBNP than patients with HHD, as the pathophysiological mechanism leading to this disease is infiltrative cardiomyopathies. This initially causes diastolic dysfunction, resulting in increased left ventricular filling pressure and parietal stress, which disproportionately increases NT-ProBNP values. Additionally, amyloid deposits cause cardiomyocyte necrosis and fibrosis, and ischaemia in relation to intramural vessel obstruction, which may lead to persistent elevation of hs-Tnl.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> In our series, creatinine levels were similar and within normal ranges. In both ATTR and HHD, the deterioration of renal function is multifactorial, especially affected by the prolonged activation of the renin-angiotensin-aldosterone axis. While the activation in ATTR may be caused by amyloid infiltration of glomeruli, arterioles and renal arteries,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> in HHD the system is activated by decreased renal perfusion due to congestive HF or, more commonly, by prerenal vasoconstriction as a compensatory mechanism against HBP, long before the onset of congestive HF.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Regarding the surface electrocardiogram findings, the higher frequency of any type of atrioventricular and intraventricular conduction disturbances seen in ATTR could be explained by amyloid deposition on the conduction tissue.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Furthermore, in vitro studies show that numerous transthyretin variants are cytotoxic to human cardiomyocytes in a concentration-dependent manner, causing oxidative stress, apoptosis and altered intracellular calcium signalling, the latter resulting in action potential prolongation.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Early sympathetic nerve fibre loss has been evidenced in ATTR, which may be due to amyloid deposition in the interstitial space, promoting interstitial remodeling.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Although this causal relationship has not yet been demonstrated, the fact that transthyretin is neurotoxic both in vitro and in vivo supports this hypothesis, and could also explain the conduction disturbances.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a> Due to the prevalence of atrioventricular and intraventricular conduction disturbances in ATTR, patients will more likely end up needing a PPM, as identified in our series. In fact, a study by Pericet et al. showed that patients diagnosed with CA who presented a complete bundle branch block on ECG were more likely to require a PPM at follow-up, especially if the diagnosis is ATTR.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> In our series, there was an ATTR trend towards a greater increase in the need for a PPM in a shorter time after symptom onset (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Also, our series shows a higher percentage of pseudoinfarction pattern in ATTR, which coincides with the evidence already available where up to 70% of patients with CA present this alteration in the ECG.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> In both diseases this pattern could be due to two aetiopathogenic mechanisms: LVH (more prominent in ATTR than in HHD) and fibrosis.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> The presence of low ECG voltages, although classically described in amyloidosis, was only seen in one third of patients in our series, and without statistically significant differences with respect to HHD. In ATTR, the presence of low voltages could be due to the fact that the greater degree of hypertrophy caused in this infiltrative disease is not due to an increase in muscle mass, but rather due to a greater deposit of amyloid material in the interstitial space. This would not generate electrical voltage, hence the electrocardiographic expression of low voltage for the greater degree of hypertrophy visualised in the imaging test. Fibrosis could also explain this finding in HHD. It is therefore understandable that in our series a similar presence of low voltages was found in both diseases.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>The TTE of ATTR shows higher ventricular filling pressures (assessed by the E/e' ratio). These are to be expected as already mentioned, due to the mechanism of infiltrative cardiomyopathies, which in turn explains the higher LVH<a class="elsevierStyleCrossRef" href="#bib0020">4</a>; this rise in intraventricular pressure results in a retrograde increase in atrial cavity pressures, with the consequent dilatation of this cavity, which leads to a greater fall in AF. As a result of this infiltration caused by amyloid in the myocardial tissue, a granular speckling of the myocardium may occur, which occurs much more frequently in ATTR than in HHD and this would be the most characteristic echocardiographic manifestation of infiltrative cardiomyopathy. In contrast, in our population there are no differences of pericardial effusion presence, and this differs from previous studies, which have shown a high prevalence of pericardial effusion in CA,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> whereas in HHD it occurs sporadically.With regard to prognosis, it should be borne in mind that both cardiopathies progress in advanced stages to HFrEF. In the pathogenesis of HFrEF, as in HFpEF, neurohumoral activation plays a relevant role, but the presence of cardiomyocyte damage is undoubtedly essential.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Given that the main cause of death in CA is cardiovascular events,<a class="elsevierStyleCrossRef" href="#bib0155">31</a> it seems logical that our study shows a trend towards higher mortality in a shorter time for patients with ATTR, since, as already mentioned, compared to HHD, ATTR progresses more frequently towards HFrEF, is more arrhythmogenic, elevates cardiac markers more frequently and modifies the cardiac architecture more. Similarly, the underdiagnosis of ATTR that we have been pointing out would adversely affect the prognosis of patients suffering from it, since, although therapy in both entities is aimed at improving quality of life and avoiding hospitalisation for heart failure, in the case of HHD there are many highly effective drugs for the HBP and thus slow progression, while in ATTR, therapeutic advances to date have been limited.Finally, in our series, the time to hospitalisation for HF from the onset of symptoms is similar in both diseases. In our series, the time to hospitalisation was analysed taking into account only HF as the reason for admission, but it is true that many of these patients are also admitted for other reasons that may be more or less attributable to their disease. It is known that only 20% of patients with HFpEF who are hospitalised are admitted for HF, with non-cardiovascular causes being more common due to concomitant comorbidities. This fits perfectly with the type of patient in our cohort, whose median age is 76 years, and who has multiple comorbidities.<a class="elsevierStyleCrossRef" href="#bib0160">32</a>The main limitation of this study is its small sample size, as it is a single-centre study, and it has not been possible to recruit a larger number of patients so far. Therefore, it would be necessary to carry out future studies with a larger cohort and a longer follow-up period to clarify the reality of the findings of the present study.ConclusionsPatients with ATTR showed significant clinical, electrocardiographic and echocardiographic differences compared to patients with HHD. These differences may serve to guide the diagnostic suspicion towards one or the other disease in daily clinical practice. We found that patients with ATTR had a greater need for a PPM at follow-up, but no differences in mortality, hospital admissions for heart failure or development of atrial fibrillation, compared to patients with HHD.This study has been approved by the Cordoba Research Ethics Committee: TFG-JLMM-2020.FundingThe authors declare that they have not received any funding for this work.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2098869" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials y methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1788381" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2098870" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1788380" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Type of study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical and laboratory variables" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Electrocardiographic variables" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Echocardiographic variables" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Outcome variables" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical study" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Clinical features" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Analytical results" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Electrocardiographic parameters" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Echocardiographic data" ] ] ] 7 => array:2 [ "identificador" => "sec0080" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-15" "fechaAceptado" => "2023-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1788381" "palabras" => array:5 [ 0 => "Cardiac amyloidosis" 1 => "Hypertensive heart disease" 2 => "Heart failure" 3 => "Pacemaker" 4 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1788380" "palabras" => array:5 [ 0 => "Amiloidosis cardíaca por transtirretina" 1 => "Cardiopatía hipertensiva" 2 => "Insuficiencia cardíaca" 3 => "Marcapasos" 4 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionA significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. Materials y methodsWe retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-Diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. ResultsA total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for herart failure (HF). ConclusionsIn our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials y methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónUn porcentaje importante de pacientes finalmente diagnosticados de amiloidosis cardíaca por transtirretina (ATTR) fueron previamente diagnosticados de cardiopatía hipertensiva (CHTA), ya que ambas enfermedades suelen cursar con insuficiencia cardíaca (IC) con fracción de eyección preservada (ICFEp) e hipertrofia ventricular. Nuestros objetivos fueron evaluar las diferencias clínicas, electrocardiográficas y ecocardiográficas, y analizar si existe un pronóstico diferencial entre ambas entidades nosológicas. Material y métodosSe incluyeron retrospectivamente todos los pacientes con CHTA a los que se solicitó una gammagrafía cardíaca con 99mTc-Difosfonatos (GDPD) y estudio de cadenas ligeras en sangre y orina para despistaje de ATTR en nuestro centro, en el periodo 2016−2021. Para el análisis, se excluyeron aquellos diagnosticados de otros tipos de amiloidosis. ResultadosSe analizaron un total de 72 pacientes: 33 fueron diagnosticados de ATTR y 39 de CHTA, finalmente. Los pacientes con ATTR presentaron mayores niveles de troponina I ultrasensible (TnI-US) y pro-péptido natriurético cerebral N-terminal (NT-ProBNP); en electrocardiograma (ECG) presentaron más frecuentemente patrón de pseudoinfarto y alteraciones de la conducción; en ecocardiograma (ETT) presentaron mayor grado de hipertrofia ventricular, disfunción ventricular izquierda y parámetros de peor función diastólica, con presiones de llenado más elevadas. En el seguimiento a 4 años, el grupo de ATTR mostró mayor necesidad de marcapasos (MCP), sin evidenciarse evidencias en cuanto a mortalidad, desarrollo de fibrilación auricular, o más ingresos por IC. ConclusionesEn nuestra serie, los pacientes con ATTR presentaron diferencias clínicas, electrocardiográficas y ecocardiográficas respecto a aquellos con CHTA, con mayor riesgo necesidad de marcapasos en el seguimiento." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "The names of the members of the Heart Failure Working Group of the Reina Sofía Hospital are listed in <a class="elsevierStyleCrossRef" href="#sec0100">Annex 1</a>." "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "Gallo-Fernández, Ignacioa,b; López-Aguilera, Joséa,b; González-Manzanares, Rafaela,b; Pericet-Rodriguez, Cristinaa,b; Carmona-Rico, Manuel Jesúsc; Perea-Armijo, Jorgea,b; Castillo-Domínguez, Juan Carlosa,b; Anguita-Sánchez, Manuela,b; Ruiz de Castroviejo, Joaquina,b; Crespin-Crespin, M.a,b; Ruiz-Ortiz, M.a,b; Delgado-Ortega, Mónicaa,b; Mesa-Rubio, Doloresa,b; Rodriguez-Almodóvar, A.a,b and Pan-Álvarez Osorio, Manuela,b aHeart Failure Unit, Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain. bInstituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, Spain. cUniversity of Cordoba, Cordoba, Spain." "titulo" => "Annex 1. Working Group on Heart Failure of the Reina Sofia University Hospital of Cordoba" "identificador" => "sec0100" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1767 "Ancho" => 1642 "Tamanyo" => 171164 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart of study patients. ATTR: cardiac transthyretin amyloidosis; HHD: hypertensive heart disease; DPD: 99mTc-Diphosphonates scintigraphy." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1506 "Ancho" => 2159 "Tamanyo" => 187271 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve of time to all-cause death in patients with ATTR vs HHD. ATTR: t cardiac transthyretin amyloidosis; HHD: hypertensive heart disease." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1503 "Ancho" => 2172 "Tamanyo" => 179620 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve of time to the need for a PPM in patients with ATTR vs HHD. ATTR: cardiac transthyretin amyloidosis; HHD: hypertensive heart disease; PPM: pacemaker." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1488 "Ancho" => 2156 "Tamanyo" => 177110 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve of time to development of AF in patients with ATTR vs HHD. ATTR: cardiac transthyretin amyloidosis; HHD: hypertensive heart disease; AF: atrial fibrillation." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1489 "Ancho" => 2158 "Tamanyo" => 173075 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve of time to HF hospitalisation in patients with ATTR vs HHD. ATTR: cardiac transthyretin amyloidosis; HHD: hypertensive heart disease; HF: heart failure." ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AF: atrial fibrillation; ATTR-CM: transthyretin cardiac amyloidosis; AV block: atrioventricular block; HHD: hypertensive heart disease; hs-Tnl: high-sensitivity troponin; IQR: interquartile range; IVS: interventricular septum; LA: left atrium; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; NT-ProBNP: brain natriuretic propeptide; RBBB: right bundle branch block; SD: standard deviation." "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="\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">Total \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">ATTR-CMN = 33 \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">HHDN = 39 \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">Value of p \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">Age (median, IQR) \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 (69−83) \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">80 (72.5−85.5) \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">75 (68.5−80.5) \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">0.058 \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">Male (%) \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 (52.8%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (69.7%) \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 (38.5%) \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">0.010 \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 " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analytical data</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">Creatinine (mg/dl) (median, IQR) \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">1.00 (0.86−1.74) \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">1.12 (0.96−1.82) \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">0.95 (0.77−1.64) \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">0.767 \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">hs-Tnl (ng/l) (median, IQR) \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">45.5 (12.5−96.3) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 (37−810) \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">30 (10−53.5) \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">0.001 \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">NT-ProBNP pg/mL (median, IQR) \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">4477.5 (2684.5−9590.5) \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">8770 (6443−16246) \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">2756 (1398−4477.5) \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">0.010 \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="5" align="left" valign="\n \t\t\t\t\ttop\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 " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electrocardiographic data</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">Pseudo-infarction pattern \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 (38.8%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (54.5%) \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">10 (25.6%) \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">0.009 \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">Low voltage \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">25 (34.7%) \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 (39%) \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 (30.7%) \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">0.379 \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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (30%) \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">16 (48.4%) \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">6 (15.4%) \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">0.005 \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">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">5 (7%) \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 (6.1%) \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">3 (7.7%) \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">0.799 \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">RBBB \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 (11.1%) \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">7 (21.2%) \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">1 (2.6%) \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">0.024 \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">Any disturbance conduction \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 (46%) \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 (63.6%) \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">12 (31%) \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">0.007 \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">Total AF \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">49 (68.1%) \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">26 (78.8%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (59%) \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">0.072 \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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (16.7%) \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 (27.3%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (7.7%) \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">0.026 \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="5" align="left" valign="\n \t\t\t\t\ttop\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 " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Echocardiographic data</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">IVS mm (median, IQR) \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 (13−18) \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">16 (14−19) \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="\n \t\t\t\t\ttop\n \t\t\t\t">14 (12−16) \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></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 preserved \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">53 (73.6%) \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">16 (48.5%) \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">37 (97.4%) \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">0.001 \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">LA dilated \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">50 (69.4%) \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">25 (75.8%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (62.9%) \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">0.285 \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">E/e' (mean, SD) \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">12.2 ± 5.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6 ± 5.4 \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">10.2 ± 4.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \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">Pericardial effusion \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 (12.5%) \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">3 (9.1%) \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">6 (15.4%) \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">0.489 \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">Speckled \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">16 (22.2%) \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">14 (42.4%) \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">2 (5.1%) \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">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3473073.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical, analytical, electrocardiographic and echocardiographic differential characteristics between ATTR and HHD." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.A. McDonagh" 1 => "M. Metra" 2 => "M. Adamo" 3 => "R.S. Gardner" 4 => "A. Baumbach" 5 => "M. Böhm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J." "fecha" => "2021" "volumen" => "42" "paginaInicial" => "3599" "paginaFinal" => "3726" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Research priorities for heart failure with preserved ejection fraction: national heart, lung, and blood institute working group summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Shah" 1 => "B.A. Borlaug" 2 => "D.W. Kitzman" 3 => "A.D. McCulloch" 4 => "B.C. Blaxall" 5 => "R. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.119.041886" "Revista" => array:6 [ "tituloSerie" => "Circulation." "fecha" => "2020" "volumen" => "141" "paginaInicial" => "1001" "paginaFinal" => "1026" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32202936" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of heart failure in the Spanish general population aged over 45 years. The PRICE Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Anguita Sánchez" 1 => "M.G. Crespo Leiro" 2 => "E. de Teresa Galván" 3 => "M. Jiménez Navarro" 4 => "L. Alonso- Pulpón" 5 => "J. Muñiz García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1885-5857(09)60007-4" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol." "fecha" => "2008" "volumen" => "61" "paginaInicial" => "1041" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18817680" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The progression of hypertensive heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.H. Drazner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.845792" "Revista" => array:6 [ "tituloSerie" => "Circulation." "fecha" => "2011" "volumen" => "123" "paginaInicial" => "327" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21263005" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. González-López" 1 => "M. Gallego-Delgado" 2 => "G. Guzzo-Merello" 3 => "F.J. De Haro-del Moral" 4 => "M. Cobo-Marcos" 5 => "C. Robles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv338" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J." "fecha" => "2015" "volumen" => "36" "paginaInicial" => "2585" "paginaFinal" => "2594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26224076" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Garcia-Pavia" 1 => "C. Rapezzi" 2 => "Y. Adler" 3 => "M. Arad" 4 => "C. Basso" 5 => "A. Brucato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehab072" "Revista" => array:6 [ "tituloSerie" => "Eur hEART j." "fecha" => "2021" "volumen" => "42" "paginaInicial" => "1554" "paginaFinal" => "1568" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33825853" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Baseline ECG features and arrhythmic profile in trnasthyretin versus light chain cardiac amyloidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Cappeli" 1 => "E. Vignini" 2 => "R. Martone" 3 => "S. Perlini" 4 => "R. Mussinelli" 5 => "A. Sabena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.119.006619" "Revista" => array:4 [ "tituloSerie" => "Circ Heart Fail." "fecha" => "2020" "volumen" => "13" "numero" => "3" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction diturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Surawicz" 1 => "R. Childers" 2 => "B.J. Deal" 3 => "L.S. Gettes" 4 => "J.J. Bailey" 5 => "A. Gorgels" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "976" "paginaFinal" => "981" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of transthyretin amyloidosis among heart failure patients with preserved ejection fraction in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Naito" 1 => "K. Nakamura" 2 => "Y. Abe" 3 => "H. Watanabe" 4 => "S. Sakuragi" 5 => "Y. Katayama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "ESC Heart Fail." "fecha" => "2023" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic amyloidosis journey from diagnosis to outcomes: a twelve-year real-world experience of a single center in a middle-income country" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.S. Szor" 1 => "F. Fernandes" 2 => "A.M.M. Lino" 3 => "L.O. Mendonça" 4 => "F.S. Seguro" 5 => "V.A. Feitosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13023-022-02584-3" "Revista" => array:5 [ "tituloSerie" => "Orphanet J Rare Dis." "fecha" => "2022" "volumen" => "17" "paginaInicial" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36471404" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y tratamiento de la amiloidosis cardiaca por trantiretina. Progreso y esperanza" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. González-López" 1 => "Á López-Sainz" 2 => "P. Garcia-Pavia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol." "fecha" => "2017" "volumen" => "70" "paginaInicial" => "991" "paginaFinal" => "1004" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sex- related risk of cardiac involvement in hereditary transthyretin amyloidosis: insights from THAOS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.G. Caponetti" 1 => "C. Rapezzi" 2 => "C. Gagliardi" 3 => "A. Milandri" 4 => "A. Dispenzieri" 5 => "A.V. Kristen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jchf.2021.05.005" "Revista" => array:6 [ "tituloSerie" => "JACC Heart Fail." 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"fecha" => "2021" "volumen" => "16" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure and heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Oh" 1 => "H.J. Cho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Hypertens." "fecha" => "2020" "volumen" => "26" "paginaInicial" => "1" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrophysiological manifestations of cardiac amyloidosis: JACC: CardioOncology State-of-the-Art Review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hartnett" 1 => "W. Jaber" 2 => "M. Maurer" 3 => "B. Sperry" 4 => "M. Hanna" 5 => "P. Collier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JACC Cardio Oncol." "fecha" => "2021" "volumen" => "3" "paginaInicial" => "506" "paginaFinal" => "515" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. Healey" 1 => "S.J. Conolly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9149(03)00227-3" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol." "fecha" => "2003" "volumen" => "91" "paginaInicial" => "9G" "paginaFinal" => "14G" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12781903" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in racial/ethnic and nativity disparities in cardiovascular health among adults without prevalent cardiovascular disease in the United States, 1988 to 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.F. Brown" 1 => "L.J. Liang" 2 => "S.D. Vassar" 3 => "J.J. Escarce" 4 => "S.S. Merkin" 5 => "E. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M17-0996" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2018" "volumen" => "168" "paginaInicial" => "541" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29554692" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial hypertrophy and its role in heart failure with preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.R. Heinzel" 1 => "F. Hohendanner" 2 => "G. Jin" 3 => "S. Sedej" 4 => "F. Edelmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/japplphysiol.00374.2015" "Revista" => array:6 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "2015" "volumen" => "119" "paginaInicial" => "1233" "paginaFinal" => "1242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26183480" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac amyloidosis: the heart of the matter" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Perfetto" 1 => "F. Cappelli" 2 => "F. Bergesio" 3 => "G. Ciuti" 4 => "M.C. Porciani" 5 => "L. Padeletti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-011-0647-y" "Revista" => array:6 [ "tituloSerie" => "Intern Emerg Med." "fecha" => "2013" "volumen" => "8" "paginaInicial" => "191" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21739229" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transthyretin amyloidosis and the kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Lobato" 1 => "A. Rocha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.08720811" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol." "fecha" => "2012" "volumen" => "7" "paginaInicial" => "1337" "paginaFinal" => "1346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22537653" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal function in patients with hypertension associated congestive cardiac failure seen in a tertiary hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.U. Osuji" 1 => "C.U. Nwaneli" 2 => "B.J. Onwubere" 3 => "E.I. Onwubuya" 4 => "G.I. Ahaneku" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Nephrol." "fecha" => "2012" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of transthyretin cardiomyocyte toxicity inhibition by resveratrol analogs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Bourgault" 1 => "S. Choi" 2 => "J.N. Buxbaum" 3 => "J.W. Kelly" 4 => "J.L. Price" 5 => "N. Reixach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbrc.2011.04.133" "Revista" => array:6 [ "tituloSerie" => "Biochem Biophys Res Commun." "fecha" => "2011" "volumen" => "410" "paginaInicial" => "707" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21557933" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac sympathetic denervation in wild-type transthyretin amyloidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gimelli" 1 => "A. Aimo" 2 => "G. Vergaro" 3 => "D. Genovesi" 4 => "V. Santonato" 5 => "A. Kusch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/13506129.2020.1769059" "Revista" => array:6 [ "tituloSerie" => "Amyloid." "fecha" => "2020" "volumen" => "27" "paginaInicial" => "237" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32441155" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deposition of transthyretin in early stages of familial amyloidotic polyneuropathy: evidence for toxicity of nonfibrillar aggregates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.M. Sousa" 1 => "I. Cardoso" 2 => "R. Fernandes" 3 => "A. Guimarães" 4 => "M.J. Saraiva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9440(10)63050-7" "Revista" => array:6 [ "tituloSerie" => "Am J Pathol." "fecha" => "2001" "volumen" => "159" "paginaInicial" => "1993" "paginaFinal" => "2000" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11733349" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial amyloid polyneuropathy: receptor for advanced glycation end products-dependent triggering of neuronal inflammatory and apoptotic pathways" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Sousa" 1 => "S. Du Yan" 2 => "R. Fernandes" 3 => "A. Guimarães" 4 => "D. Stern" 5 => "M.J. Saraiva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1523/JNEUROSCI.21-19-07576.2001" "Revista" => array:6 [ "tituloSerie" => "J Neurosci" "fecha" => "2001" "volumen" => "21" "paginaInicial" => "7576" "paginaFinal" => "7586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11567048" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alteraciones electrocardiográficas y necesidad de marcapasos en amiloidosis cardiaca: análisis de 58 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Pericet Rodriguez" 1 => "J. López Aguilera" 2 => "C. Durán Torralba" 3 => "J.C. Castillo Domínguez" 4 => "M. Ruiz Ortiz" 5 => "J. Perea" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2022" "volumen" => "159" "paginaInicial" => "178" "paginaFinal" => "184" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac amyloidosis: the great pretender" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Rapezzi" 1 => "M. Lorenzini" 2 => "S. Longhi" 3 => "A. Milandri" 4 => "C. Gagliardi" 5 => "I. Bartolomei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10741-015-9480-0" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Rev." "fecha" => "2015" "volumen" => "20" "paginaInicial" => "117" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758359" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoinfarctions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.O. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Circulation." "fecha" => "2001" "volumen" => "103" "paginaInicial" => "e69" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diffuse myocardial fibrosis reduces electrocardiographic voltage measures of left ventricular hypertrophy independent of left ventricular mass" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Maanja" 1 => "B. Wieslander" 2 => "T.T. Schlegel" 3 => "L. Bacharova" 4 => "H. Abu Daya" 5 => "Y. Fridman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Am Heart Assoc." "fecha" => "2017" "volumen" => "6" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. González-López" 1 => "M. Gallego-Delgado" 2 => "G. Guzzo-Merello" 3 => "F.J. de Haro-Del Moral" 4 => "M. Cobo- Marcos" 5 => "C. Robles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv338" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J." "fecha" => "2015" "volumen" => "36" "paginaInicial" => "2585" "paginaFinal" => "2594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26224076" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "When and how do patients with cardiac amyloidosis die?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Escher" 1 => "M. Senoner" 2 => "J. Doerler" 3 => "M.M. Zaruba" 4 => "M. Messner" 5 => "C. Mussner-Seeber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Res Cardiol." "fecha" => "2020" "volumen" => "109" "paginaInicial" => "78" "paginaFinal" => "88" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalisation in patients with heart failure with preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Nanayakkara" 1 => "H.C. Patel" 2 => "D.M. Kaye" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Med Insights Cardiol." "fecha" => "2018" "volumen" => "12" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000005/v1_202403010948/S2387020624000457/v1_202403010948/en/main.assets" "Apartado" => array:4 [ "identificador" => "43310" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000005/v1_202403010948/S2387020624000457/v1_202403010948/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000457?idApp=UINPBA00004N"]

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Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease

Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva

Ignacio Gallo-Fernándeza,b, José López-Aguileraa,b,

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mircardjla@gmail.com

Corresponding author.

, Rafael González-Manzanaresa,b, Cristina Pericet-Rodrigueza,b, Manuel Jesús Carmona-Ricoc, Jorge Perea-Armijoa,b,c, Juan Carlos Castillo-Domíngueza,b, Manuel Anguita-Sáncheza,b, on behalf of the members of the Heart Failure Working Group of the Reina Sofía Hospital ◊

a Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain

b Instituto de Investigación Biomédica de Córdoba, IMIBIC, Cordoba, Spain

c Universidad de Córdoba, Cordoba, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure with preserved ejection fraction &#40;HFpEF&#41; is an entity on the increase in our environment&#44; probably due to the ageing of the population and the increase of risk factors such as obesity&#44; diabetes mellitus or arterial hypertension&#46; It is the outcome of many diseases affecting the heart&#44; including valvular heart disease&#44; hypertensive heart disease&#44; ischaemic heart disease&#44; pericardial disease and infiltrative diseases such as cardiac amyloidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main causes of HFpEF is hypertensive heart disease &#40;HHD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and it has been documented that in up to 13&#37; of patients with HFpEF&#44; if the aetiological study is performed correctly&#44; the final diagnosis would be ATTR&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Given that HHD and cardiac transthyretin amyloidosis &#40;ATTR&#41; are 2 common aetiologies in HFpEF&#44; and that many final diagnoses of ATTR are misdiagnoses of HHD&#44; it is appropriate to investigate whether they have differential characteristics or whether there is a different prognostic evolution between the two causes of HFpEF&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus&#44; the objective of this study was to describe the clinical&#44; electrocardiographic and echocardiographic characteristics of patients with ATTR and HHD&#46; We also studied the prognostic evolution of both heart diseases in terms of all-cause mortality&#44; hospital admissions due to heart failure&#44; the need for a pacemaker &#40;PPM&#41;&#44; and time until the first episode of atrial fibrillation &#40;AF&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Type of study</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational&#44; retrospective&#44; longitudinal and analytical study was conducted at the Reina Sofia University Hospital of Cordoba &#40;HURS&#41; from January 2016 to December 2021&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study included patients from the outpatients clinic as well as patients discharged after hospital admission for heart failure &#40;HF&#41;&#46; The diagnosis of ATTR or HHD was made according to the following criteria&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patients diagnosed with ATTR</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#58; those with Perugrini grade 2 or 3 cardiac uptake in the <span class="elsevierStyleSup">99m</span>Tc-Diphosphonates &#40;DPD scintigraphy&#41;&#44; and in whom there was no evidence of monoclonal gammopathy &#40;absence of paraprotein in blood&#44; kappa and lambda light chains in serum and urine immunofixation&#44; and a normal kappa&#47;lambda ratio&#41;&#46; Genetic studies were carried out on all patients&#46; Patients with a final diagnosis of cardiac amyloidosis other than ATTR were excluded from the analysis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patients with a diagnosis of HHD&#58;</span> patients with long-standing HF&#44; LVH and HT&#44; whose hypertrophy could not be justified by any other cause&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical and laboratory variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data related to the final aetiological diagnosis &#40;HHD&#47;ATTR&#41;&#44; age at diagnosis &#40;years&#41;&#44; sex&#44; creatinine level &#40;mg&#47;dl&#41;&#44; hs-Tnl level &#40;ng&#47;l&#41; and NT-proBNP level &#40;pg&#47;mL&#41; at diagnosis were analysed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Electrocardiographic variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">Baseline electrocardiogram data were analysed for&#58; rhythm at diagnosis &#40;sinus rhythm or atrial fibrillation&#41;&#44; presence of a pseudoinfarction pattern&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> low voltage pattern&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> AV block of any type&#44; complete left bundle branch block&#44; complete right bundle branch block&#44; or the need for cardiac pacing by a PPM at the time of diagnosis&#46; The presence of conduction disturbances was defined according to the American Heart Association diagnostic criteria for standardisation and interpretation of the surface electrocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Echocardiographic variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">Data from the transthoracic echocardiogram &#40;TTE&#41; baseline evaluation&#44; at the time of diagnosis&#44; were analysed&#46; Variables of interest were&#58; LVEF &#40;&#37;&#41;&#44; determined by Teicholz or Simpson method&#59; interventricular septum &#40;IVS&#41; thickness &#40;mm&#41;&#44; dilated atrium &#40;Yes&#47;No&#41;&#44; mean E&#47;e&#39; value &#40;absolute number&#41;&#44; presence of pericardial effusion &#40;Yes&#47;No&#41; and speckle pattern &#40;Yes&#47;No&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Outcome variables</span><p id="par0055" class="elsevierStylePara elsevierViewall">Prognosis was evaluated by the development of all-cause mortality&#44; hospital admissions for heart failure&#44; need for a PPM&#44; and time until the first episode of atrial fibrillation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical study</span><p id="par0060" class="elsevierStylePara elsevierViewall">A descriptive study of the qualitative variables was carried out&#44; 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as appropriate&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">To compare nominal qualitative variables&#44; the Chi-square statistic or Fisher&#39;s exact test was used as appropriate&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">Event-free survival &#40;time to death from any cause&#44; first admission for HF&#44; need for a PPM and development of AF&#41; was analysed using the Kaplan-Meier method and the two groups were compared using the log-rank test&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">All contrasts were bilateral and those where p was less than 0&#46;05 were considered significant&#46; Data were collected&#44; processed and analysed with SPSS&#174; statistical software version 26&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical considerations</span><p id="par0090" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of the HURS&#44; via the Andalusian Biomedical Research Ethics Portal &#40;Code TFG-JLMM-2020&#44; dated 09&#47;12&#47;2020&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">This project has followed the standards of good clinical practice and has been conducted in accordance with the principles set out in the Declaration of Helsinki&#46; The data has been anonymised&#44; respecting the confidentiality of the same&#44; in accordance with Regulation &#40;EU&#41; 2016&#47;679 of the European Parliament and Organic Law 3&#47;2018 of 5 December on the Protection of Personal Data and guarantee of digital rights&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Clinical features</span><p id="par0100" class="elsevierStylePara elsevierViewall">The study cohort included 72 patients with a previous diagnosis of HHD who had undergone a DPD scintigraphy study to screen for ATTR&#44; and a light chain study to rule out amyloidosis &#40;AL&#41;&#46; Of these&#44; 33 patients were finally diagnosed with ATTR &#40;46&#37;&#41; and 39 patients had a final diagnosis of HHD &#40;54&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The genetic study was positive in only 6 patients &#40;18&#37;&#41; giving the diagnosis as hereditary ATTR &#40;hATTR&#41;&#44; and negative in 27 patients &#40;82&#37;&#41; giving the diagnosis as wild-type ATTR &#40;ATTRwt&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">No differences were found between the median age at diagnosis of the two groups &#40;p&#8239;&#61;&#8239;0&#46;058&#41;&#46; The median age at diagnosis for the group diagnosed with ATTR was 80 years &#40;IQR&#58; 72&#46;5&#8722;85&#46;5&#41; and for the group diagnosed with HHD it was 75 years &#40;IQR&#58; 68&#46;5&#8722;80&#46;5&#41;&#46; The sex variable showed a higher frequency of males in the ATTR diagnosed group compared to the HHD diagnosed group &#40;69&#46;7 vs&#46; 38&#46;5&#37;&#59; p&#8239;&#61;&#8239;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The presence of AF &#40;pre-study or developed during follow-up&#41; was 78&#46;8&#37; in the ATTR group and 59&#37; in the HHD group&#44; with no statistically significant differences &#40;p&#8239;&#61;&#8239;0&#46;072&#41;&#46; As for the need for a PPM&#44; it was higher in ATTR patients &#40;27&#46;3&#37;&#41; compared to HHD patients &#40;7&#46;7&#37;&#41;&#59; p&#8239;&#61;&#8239;0&#46;026 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Analytical results</span><p id="par0115" class="elsevierStylePara elsevierViewall">With respect to blood test variables&#44; statistically significant differences were detected between hs-Tnl and NT-proBNP levels in both groups&#44; with higher levels in the ATTR group compared to patients diagnosed with HHD &#40;double the hs-Tnl value&#44; and up to four times higher in NT-proBNP value&#41;&#46; However&#44; there were no differences in creatinine levels in patients diagnosed with ATTR compared to patients with HHD &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Electrocardiographic parameters</span><p id="par0120" class="elsevierStylePara elsevierViewall">Some differences were found in the electrocardiographic parameters&#46; The ATTR group showed a higher frequency of <span class="elsevierStyleItalic">pseudoinfarction</span> pattern &#40;54&#46;5 vs&#46; 25&#46;6&#37;&#59; p&#8239;&#61;&#8239;0&#46;009&#41;&#44; AV block of any type &#40;48&#46;4 vs&#46; 15&#46;4&#37;&#59; p&#8239;&#61;&#8239;0&#46;005&#41;&#44; conduction disturbances in general &#40;63&#46;6 vs&#46; 31&#37;&#59; p&#8239;&#61;&#8239;0&#46;007&#41; and specifically LBBB &#40;21&#46;1 vs&#46; 2&#46;6&#37;&#59; p&#8239;&#61;&#8239;0&#46;024&#41;&#46; In contrast&#44; no differences were found between the two groups regarding the presence of low voltage pattern &#40;39 vs&#46; 30&#46;7&#37;&#59; p&#8239;&#61;&#8239;0&#46;379&#41; or for the presence of RBBB &#40;6&#46;1 vs&#46; 7&#46;7&#37;&#59; p&#8239;&#61;&#8239;0&#46;799&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Echocardiographic data</span><p id="par0125" class="elsevierStylePara elsevierViewall">Differences were also found in the TTE variables&#58; patients with ATTR had greater IVS thickness &#40;median 16&#8239;mm &#91;IQR of 14&#8722;19&#8239;mm&#93; vs&#46; median 14&#8239;mm &#91;IQR of 12&#8722;16&#8239;mm&#93;&#44; p&#8239;&#61;&#8239;0&#46;001&#41;&#44; higher mean E&#47;e&#39; value &#40;mean 14&#46;6&#8239;&#177;&#8239;5&#46;4 vs&#46; mean of 10&#46;2&#8239;&#177;&#8239;4&#46;3&#59; p&#8239;&#61;&#8239;0&#46;007&#41; and higher presence of myocardial granular speckling &#40;42&#46;4 vs&#46; 5&#46;1&#37;&#59; p&#8239;&#61;&#8239;0&#46;001&#41;&#46; On the other hand&#44; the presence of preserved LVEF was lower in the ATTR group &#40;48&#46;5&#37;&#41; than in the HHD group &#40;97&#46;4&#37;&#41;&#59; p&#8239;&#61;&#8239;0&#46;001&#46; No differences were found in the presence of dilated atrium &#40;75&#46;8 vs&#46; 62&#46;9&#37;&#59; p&#8239;&#61;&#8239;0&#46;285&#41; or pericardial effusion &#40;9&#46;1 vs&#46; 15&#46;4&#37;&#59; p&#8239;&#61;&#8239;0&#46;489&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Prognosis&#58; mortality&#44; readmission for heart failure&#44; need for pacemaker and development of atrial fibrillation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the prognostic study&#44; with a mean follow-up of 49&#46;9&#8239;&#177;&#8239;42&#46;2 months of patients with both nosological entities&#44; patients with ATTR had a higher need for a PPM at follow-up &#40;log-rank&#8239;&#61;&#8239;0&#46;034&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; However&#44; no statistically significant differences were found for all-cause mortality &#40;log-rank&#8239;&#61;&#8239;0&#46;06&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; time to development of AF &#40;log-rank&#8239;&#61;&#8239;0&#46;720&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; or admission for heart failure &#40;log-rank&#8239;&#61;&#8239;0&#46;650&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">ATTR is a disease that is clearly underdiagnosed&#46; It frequently remains hidden under other diagnostic entities &#40;such as the aforementioned HHD&#44; hypertrophic cardiomyopathy&#44; ischaemic heart disease or aortic stenosis&#44; among others&#41;&#44; and only when sufficient clinical suspicion is established are the appropriate complementary tests requested for the diagnosis of this entity&#46; However&#44; the implementation of non-invasive diagnosis of ATTR&#44; using a combination of DPD scintigraphy and an analytical study of light chains in urine&#44; has led to an increase in the number of diagnosed cases of ATTR in recent years&#44; in contrast to the data from years prior to this study protocol&#44; when a histological study was the gold standard&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Despite this progress&#44; there is evidence that this entity is still seriously under-diagnosed&#44; supporting the need to accurately characterise it&#46; For example&#44; some studies report that up to 70&#37; of patients obtained a definitive diagnosis of ATTR after having been assessed by 3 or more different specialists&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A phenomenon to be taken into account as a result of the new diagnostic algorithm for this disease is the possibility of a false-negative DPD scintigraphy result in patients with ATTR&#44; especially in hATTR associated with the Phe84Leu and Ser97Tyr mutation&#46; Therefore&#44; the prevalence in our population could be higher than that observed because no patient diagnosed with HHD underwent additional screening for CA&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Following along these lines&#44; as already mentioned this algorithm avoids a histological study&#44; and therefore could overlook the possibility of patients with 2 types of simultaneous cardiac amyloidosis&#44; as has been reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">One of the main differential diagnoses of ATTR is HHD&#44; as both can present as HFpEF&#58; they increase in prevalence with age&#44; share symptoms &#40;exertional dyspnoea&#44; lower limb oedema&#44; weakness&#44; tachycardia&#44; etc&#46;&#41; and have a high prevalence of AF&#46; On the other hand&#44; these entities present certain clinical differences&#58; on a symptomatic level&#44; the presence of chest pain is more frequent in HHD&#44; while extracardiac manifestations such as carpal tunnel syndrome&#44; peripheral neuropathy&#44; lumbar spinal stenosis or even ocular disorders &#40;glaucoma&#44; myodesopsias&#44; scalloped pupil&#41; would be more suggestive of ATTR&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Other differences would be gender distribution &#40;ATTR is more prevalent in men while HHD is more prevalent in women&#41; and the need for a PPM &#40;more common in ATTR than in HHD&#41;&#44; as in the findings found in our series&#46; The higher prevalence of ATTR in men than in women found in our cohort coincides with the evidence available to date on the prevalence of this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Some authors suggest that this may be due to the protective effect of oestrogens in women&#44; based on a study that showed that ATTR in women appears mainly after the menopause&#46; Also&#44; this disease may be underdiagnosed in females due to a more latent clinical presentation&#44; as a retrospective study found that post-mortem diagnosis of ATTR was higher in females than in males &#40;31 vs&#46; 9&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Although no significant differences regarding age were found in our study&#44; the HHD group tended to be younger than the ATTR group&#46; The ATTR group being older could also have to do with the delay in the diagnostic process that has traditionally taken place in this disease&#46; On the other hand&#44; given that high blood pressure &#40;HBP&#41; usually begins at a much younger age&#44; in principle it seems logical that patients with HHD are younger than those diagnosed with ATTR&#44; and the reduced difference between the two groups could be due to the fact that therapeutic advances in the control of HBP allow a delay in the progression to heart disease&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Although we do not have age-adjusted prognostic results for the events studied&#44; these would be interesting&#44; when we consider the older age of patients with ATTR and the mean follow-up of 4 years&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study also found a similar prevalence of AF in both entities&#46; This result was to be expected given that the pathophysiological mechanism that triggers this arrhythmia in both populations is fundamentally the compensatory left atrial enlargement due to chronic elevated left atrial pressure&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> although in our study we found no differences between the two groups in terms of the prevalence of left atrial enlargement&#46; We also found no differences in the time required to develop atrial fibrillation in the evolution of both nosological entities &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">On the other hand&#44; both entities often present as HFpEF&#44; an increasingly prevalent clinical syndrome&#44; accounting for up to 50&#37; of all cases of HF in some series&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> HFpEF is a catch-all for diseases of very diverse origins such as HHD&#44; ATTR&#44; sarcoidosis&#44; other infiltrative cardiomyopathies&#44; hypertrophic cardiomyopathy&#44; etc&#46;&#44; with one aspect in common - the increase in the degree of hypertrophic cardiomyopathy&#46; A multifactorial origin has been postulated for this increase&#44; where the different cardiovascular risk factors &#40;HBP&#44; diabetes&#44; ageing&#44; obesity&#44; chronic kidney disease&#44; etc&#46;&#44;&#41; contribute towards generating a state of low-grade systemic inflammation and neurohumoral activation &#40;mainly through the renin-angiotensin-aldosterone axis&#41;&#46; This would trigger ventricular hypertrophy as a compensatory mechanism in the short term&#44; but would subsequently become disproportionate&#44; ultimately triggering the clinical syndrome of heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In terms of analytical parameters&#44; it seems logical that patients with ATTR have higher levels of hs-Tnl and NT-ProBNP than patients with HHD&#44; as the pathophysiological mechanism leading to this disease is infiltrative cardiomyopathies&#46; This initially causes diastolic dysfunction&#44; resulting in increased left ventricular filling pressure and parietal stress&#44; which disproportionately increases NT-ProBNP values&#46; Additionally&#44; amyloid deposits cause cardiomyocyte necrosis and fibrosis&#44; and ischaemia in relation to intramural vessel obstruction&#44; which may lead to persistent elevation of hs-Tnl&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In our series&#44; creatinine levels were similar and within normal ranges&#46; In both ATTR and HHD&#44; the deterioration of renal function is multifactorial&#44; especially affected by the prolonged activation of the renin-angiotensin-aldosterone axis&#46; While the activation in ATTR may be caused by amyloid infiltration of glomeruli&#44; arterioles and renal arteries&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in HHD the system is activated by decreased renal perfusion due to congestive HF or&#44; more commonly&#44; by prerenal vasoconstriction as a compensatory mechanism against HBP&#44; long before the onset of congestive HF&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Regarding the surface electrocardiogram findings&#44; the higher frequency of any type of atrioventricular and intraventricular conduction disturbances seen in ATTR could be explained by amyloid deposition on the conduction tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Furthermore&#44; in vitro studies show that numerous transthyretin variants are cytotoxic to human cardiomyocytes in a concentration-dependent manner&#44; causing oxidative stress&#44; apoptosis and altered intracellular calcium signalling&#44; the latter resulting in action potential prolongation&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Early sympathetic nerve fibre loss has been evidenced in ATTR&#44; which may be due to amyloid deposition in the interstitial space&#44; promoting interstitial remodeling&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Although this causal relationship has not yet been demonstrated&#44; the fact that transthyretin is neurotoxic both in vitro and in vivo supports this hypothesis&#44; and could also explain the conduction disturbances&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> Due to the prevalence of atrioventricular and intraventricular conduction disturbances in ATTR&#44; patients will more likely end up needing a PPM&#44; as identified in our series&#46; In fact&#44; a study by Pericet et al&#46; showed that patients diagnosed with CA who presented a complete bundle branch block on ECG were more likely to require a PPM at follow-up&#44; especially if the diagnosis is ATTR&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In our series&#44; there was an ATTR trend towards a greater increase in the need for a PPM in a shorter time after symptom onset &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Also&#44; our series shows a higher percentage of pseudoinfarction pattern in ATTR&#44; which coincides with the evidence already available where up to 70&#37; of patients with CA present this alteration in the ECG&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In both diseases this pattern could be due to two aetiopathogenic mechanisms&#58; LVH &#40;more prominent in ATTR than in HHD&#41; and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The presence of low ECG voltages&#44; although classically described in amyloidosis&#44; was only seen in one third of patients in our series&#44; and without statistically significant differences with respect to HHD&#46; In ATTR&#44; the presence of low voltages could be due to the fact that the greater degree of hypertrophy caused in this infiltrative disease is not due to an increase in muscle mass&#44; but rather due to a greater deposit of amyloid material in the interstitial space&#46; This would not generate electrical voltage&#44; hence the electrocardiographic expression of low voltage for the greater degree of hypertrophy visualised in the imaging test&#46; Fibrosis could also explain this finding in HHD&#46; It is therefore understandable that in our series a similar presence of low voltages was found in both diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The TTE of ATTR shows higher ventricular filling pressures &#40;assessed by the E&#47;e&#39; ratio&#41;&#46; These are to be expected as already mentioned&#44; due to the mechanism of infiltrative cardiomyopathies&#44; which in turn explains the higher LVH<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#59; this rise in intraventricular pressure results in a retrograde increase in atrial cavity pressures&#44; with the consequent dilatation of this cavity&#44; which leads to a greater fall in AF&#46; As a result of this infiltration caused by amyloid in the myocardial tissue&#44; a granular speckling of the myocardium may occur&#44; which occurs much more frequently in ATTR than in HHD and this would be the most characteristic echocardiographic manifestation of infiltrative cardiomyopathy&#46; In contrast&#44; in our population there are no differences of pericardial effusion presence&#44; and this differs from previous studies&#44; which have shown a high prevalence of pericardial effusion in CA&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> whereas in HHD it occurs sporadically&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">With regard to prognosis&#44; it should be borne in mind that both cardiopathies progress in advanced stages to HFrEF&#46; In the pathogenesis of HFrEF&#44; as in HFpEF&#44; neurohumoral activation plays a relevant role&#44; but the presence of cardiomyocyte damage is undoubtedly essential&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Given that the main cause of death in CA is cardiovascular events&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> it seems logical that our study shows a trend towards higher mortality in a shorter time for patients with ATTR&#44; since&#44; as already mentioned&#44; compared to HHD&#44; ATTR progresses more frequently towards HFrEF&#44; is more arrhythmogenic&#44; elevates cardiac markers more frequently and modifies the cardiac architecture more&#46; Similarly&#44; the underdiagnosis of ATTR that we have been pointing out would adversely affect the prognosis of patients suffering from it&#44; since&#44; although therapy in both entities is aimed at improving quality of life and avoiding hospitalisation for heart failure&#44; in the case of HHD there are many highly effective drugs for the HBP and thus slow progression&#44; while in ATTR&#44; therapeutic advances to date have been limited&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; in our series&#44; the time to hospitalisation for HF from the onset of symptoms is similar in both diseases&#46; In our series&#44; the time to hospitalisation was analysed taking into account only HF as the reason for admission&#44; but it is true that many of these patients are also admitted for other reasons that may be more or less attributable to their disease&#46; It is known that only 20&#37; of patients with HFpEF who are hospitalised are admitted for HF&#44; with non-cardiovascular causes being more common due to concomitant comorbidities&#46; This fits perfectly with the type of patient in our cohort&#44; whose median age is 76 years&#44; and who has multiple comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The main limitation of this study is its small sample size&#44; as it is a single-centre study&#44; and it has not been possible to recruit a larger number of patients so far&#46; Therefore&#44; it would be necessary to carry out future studies with a larger cohort and a longer follow-up period to clarify the reality of the findings of the present study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">Patients with ATTR showed significant clinical&#44; electrocardiographic and echocardiographic differences compared to patients with HHD&#46; These differences may serve to guide the diagnostic suspicion towards one or the other disease in daily clinical practice&#46; We found that patients with ATTR had a greater need for a PPM at follow-up&#44; but no differences in mortality&#44; hospital admissions for heart failure or development of atrial fibrillation&#44; compared to patients with HHD&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">This study has been approved by the Cordoba Research Ethics Committee&#58; TFG-JLMM-2020&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any funding for this work&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conclusions"
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          "identificador" => "sec0090"
          "titulo" => "Funding"
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          "identificador" => "sec0095"
          "titulo" => "Conflict of interest"
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        11 => array:1 [
          "titulo" => "References"
        ]
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-05-15"
    "fechaAceptado" => "2023-10-10"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1788381"
          "palabras" => array:5 [
            0 => "Cardiac amyloidosis"
            1 => "Hypertensive heart disease"
            2 => "Heart failure"
            3 => "Pacemaker"
            4 => "Prognosis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1788380"
          "palabras" => array:5 [
            0 => "Amiloidosis card&#237;aca por transtirretina"
            1 => "Cardiopat&#237;a hipertensiva"
            2 => "Insuficiencia card&#237;aca"
            3 => "Marcapasos"
            4 => "Pron&#243;stico"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis &#40;TTRA&#41; was previously diagnosed with hypertensive heart disease &#40;HHD&#41;&#44; since both conditions usually present with heart failure &#40;HF&#41; with preserved ejection fraction &#40;HFpEF&#41; and ventricular hypertrophy&#46; Our objectives were to evaluate the clinical&#44; electrocardiographic and echocardiographic differences&#44; and to analyse whether there exists a differential prognosis between these two nosological entities&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials y methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We retrospectively included all patients with HHD for whom a cardiac scintigraphy with <span class="elsevierStyleSup">99m</span>Tc-Diphosphonate &#40;GDPD&#41; and a free light chains test in blood and urine were ordered for ATTR screening in our centre&#44; in the period between 2016 and 2021&#46; Those diagnosed with other types of amyloidosis were excluded from the analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A total of 72 patients were analyzed&#58; 33 were finally diagnosed with TTRA and 39 with CHTA&#46; Patients with TTRA had higher levels of ultrasensitive troponin I &#40;TnI-US&#41; and N-terminal brain natriuretic propeptide &#40;NT-ProBNP&#41;&#59; in electrocardiography &#40;ECG&#41; they presented a <span class="elsevierStyleItalic">pseudo-infarction</span> pattern more frequently as well as conduction disturbances&#59; in echocardiography &#40;TTE&#41; they presented a higher degree of ventricular hypertrophy&#44; left ventricular dysfunction and worse diastolic function parameters&#44; with elevated filling pressures&#46; In the 4-year follow-up&#44; the ATTR group showed greater need for pacemaker &#40;PCM&#41;&#44; with no evidence regarding mortality&#44; development of atrial fibrillation &#40;AF&#41;&#44; or more admissions for herart failure &#40;HF&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In our series&#44; patients with TTRA showed clinical&#44; electrocardiographic and echocardiographic differences compared to patients with HHD&#44; with increased risk of need for PCM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials y methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Un porcentaje importante de pacientes finalmente diagnosticados de amiloidosis card&#237;aca por transtirretina &#40;ATTR&#41; fueron previamente diagnosticados de cardiopat&#237;a hipertensiva &#40;CHTA&#41;&#44; ya que ambas enfermedades suelen cursar con insuficiencia card&#237;aca &#40;IC&#41; con fracci&#243;n de eyecci&#243;n preservada &#40;ICFEp&#41; e hipertrofia ventricular&#46; Nuestros objetivos fueron evaluar las diferencias cl&#237;nicas&#44; electrocardiogr&#225;ficas y ecocardiogr&#225;ficas&#44; y analizar si existe un pron&#243;stico diferencial entre ambas entidades nosol&#243;gicas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron retrospectivamente todos los pacientes con CHTA a los que se solicit&#243; una gammagraf&#237;a card&#237;aca con <span class="elsevierStyleSup">99m</span>Tc-Difosfonatos &#40;GDPD&#41; y estudio de cadenas ligeras en sangre y orina para despistaje de ATTR en nuestro centro&#44; en el periodo 2016&#8722;2021&#46; Para el an&#225;lisis&#44; se excluyeron aquellos diagnosticados de otros tipos de amiloidosis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se analizaron un total de 72 pacientes&#58; 33 fueron diagnosticados de ATTR y 39 de CHTA&#44; finalmente&#46; Los pacientes con ATTR presentaron mayores niveles de troponina I ultrasensible &#40;TnI-US&#41; y pro-p&#233;ptido natriur&#233;tico cerebral N-terminal &#40;NT-ProBNP&#41;&#59; en electrocardiograma &#40;ECG&#41; presentaron m&#225;s frecuentemente patr&#243;n de <span class="elsevierStyleItalic">pseudoinfarto</span> y alteraciones de la conducci&#243;n&#59; en ecocardiograma &#40;ETT&#41; presentaron mayor grado de hipertrofia ventricular&#44; disfunci&#243;n ventricular izquierda y par&#225;metros de peor funci&#243;n diast&#243;lica&#44; con presiones de llenado m&#225;s elevadas&#46; En el seguimiento a 4 a&#241;os&#44; el grupo de ATTR mostr&#243; mayor necesidad de marcapasos &#40;MCP&#41;&#44; sin evidenciarse evidencias en cuanto a mortalidad&#44; desarrollo de fibrilaci&#243;n auricular&#44; o m&#225;s ingresos por IC&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie&#44; los pacientes con ATTR presentaron diferencias cl&#237;nicas&#44; electrocardiogr&#225;ficas y ecocardiogr&#225;ficas respecto a aquellos con CHTA&#44; con mayor riesgo necesidad de marcapasos en el seguimiento&#46;</p></span>"
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        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The names of the members of the Heart Failure Working Group of the Reina Sof&#237;a Hospital are listed in <a class="elsevierStyleCrossRef" href="#sec0100">Annex 1</a>&#46;</p>"
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            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">Gallo-Fern&#225;ndez&#44; Ignacio<span class="elsevierStyleSup">a&#44;b</span>&#59; L&#243;pez-Aguilera&#44; Jos&#233;<span class="elsevierStyleSup">a&#44;b</span>&#59; Gonz&#225;lez-Manzanares&#44; Rafael<span class="elsevierStyleSup">a&#44;b</span>&#59; Pericet-Rodriguez&#44; Cristina<span class="elsevierStyleSup">a&#44;b</span>&#59; Carmona-Rico&#44; Manuel Jes&#250;s<span class="elsevierStyleSup">c</span>&#59; Perea-Armijo&#44; Jorge<span class="elsevierStyleSup">a&#44;b</span>&#59; Castillo-Dom&#237;nguez&#44; Juan Carlos<span class="elsevierStyleSup">a&#44;b</span>&#59; Anguita-S&#225;nchez&#44; Manuel<span class="elsevierStyleSup">a&#44;b</span>&#59; Ruiz de Castroviejo&#44; Joaquin<span class="elsevierStyleSup">a&#44;b</span>&#59; Crespin-Crespin&#44; M&#46;<span class="elsevierStyleSup">a&#44;b</span>&#59; Ruiz-Ortiz&#44; M&#46;<span class="elsevierStyleSup">a&#44;b</span>&#59; Delgado-Ortega&#44; M&#243;nica<span class="elsevierStyleSup">a&#44;b</span>&#59; Mesa-Rubio&#44; Dolores<span class="elsevierStyleSup">a&#44;b</span>&#59; Rodriguez-Almod&#243;var&#44; A&#46;<span class="elsevierStyleSup">a&#44;b</span> and Pan-&#193;lvarez Osorio&#44; Manuel<span class="elsevierStyleSup">a&#44;b</span></p> <p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">a</span>Heart Failure Unit&#44; Cardiology Department&#44; Reina Sof&#237;a University Hospital&#44; C&#243;rdoba&#44; Spain&#46;</p> <p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">b</span>Instituto de Investigaci&#243;n Biom&#233;dica de C&#243;rdoba&#44; IMIBIC&#44; C&#243;rdoba&#44; Spain&#46;</p> <p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">c</span>University of Cordoba&#44; Cordoba&#44; Spain&#46;</p>"
            "titulo" => "Annex 1&#46; Working Group on Heart Failure of the Reina Sofia University Hospital of Cordoba"
            "identificador" => "sec0100"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of study patients&#46; ATTR&#58; cardiac transthyretin amyloidosis&#59; HHD&#58; hypertensive heart disease&#59; DPD&#58; <span class="elsevierStyleSup">99m</span>Tc-Diphosphonates scintigraphy&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve of time to all-cause death in patients with ATTR vs HHD&#46; ATTR&#58; t cardiac transthyretin amyloidosis&#59; HHD&#58; hypertensive heart disease&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve of time to the need for a PPM in patients with ATTR vs HHD&#46; ATTR&#58; cardiac transthyretin amyloidosis&#59; HHD&#58; hypertensive heart disease&#59; PPM&#58; pacemaker&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve of time to development of AF in patients with ATTR vs HHD&#46; ATTR&#58; cardiac transthyretin amyloidosis&#59; HHD&#58; hypertensive heart disease&#59; AF&#58; atrial fibrillation&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve of time to HF hospitalisation in patients with ATTR vs HHD&#46; ATTR&#58; cardiac transthyretin amyloidosis&#59; HHD&#58; hypertensive heart disease&#59; HF&#58; heart failure&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; ATTR-CM&#58; transthyretin cardiac amyloidosis&#59; AV block&#58; atrioventricular block&#59; HHD&#58; hypertensive heart disease&#59; hs-Tnl&#58; high-sensitivity troponin&#59; IQR&#58; interquartile range&#59; IVS&#58; interventricular septum&#59; LA&#58; left atrium&#59; LBBB&#58; left bundle branch block&#59; LVEF&#58; left ventricular ejection fraction&#59; NT-ProBNP&#58; brain natriuretic propeptide&#59; RBBB&#58; right bundle branch block&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ATTR-CMN&#8239;&#61;&#8239;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value of p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;median&#44; IQR&#41;</span>&nbsp;\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 &#40;69&#8722;83&#41;&nbsp;\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">80 &#40;72&#46;5&#8722;85&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;68&#46;5&#8722;80&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;058&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;52&#46;8&#37;&#41;&nbsp;\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
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                  \t\t\t\t">23 &#40;69&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;38&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinine &#40;mg&#47;dl&#41; &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;00 &#40;0&#46;86&#8722;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;12 &#40;0&#46;96&#8722;1&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;95 &#40;0&#46;77&#8722;1&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;767&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>hs-Tnl &#40;ng&#47;l&#41; &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45&#46;5 &#40;12&#46;5&#8722;96&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">85 &#40;37&#8722;810&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;10&#8722;53&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NT-ProBNP pg&#47;mL &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4477&#46;5 &#40;2684&#46;5&#8722;9590&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8770 &#40;6443&#8722;16246&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Electrocardiographic data</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pseudo-infarction pattern&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;25&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low voltage&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;34&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;30&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;379&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AV block&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;48&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;15&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LBBB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;6&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;799&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RBBB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;21&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Any disturbance conduction&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
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                  \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>Total AF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;68&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;78&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;072&nbsp;\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>Pacemaker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;026&nbsp;\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="5" 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 " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Echocardiographic 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>IVS mm &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14 &#40;13&#8722;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;14&#8722;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;12&#8722;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;001&nbsp;\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>LVEF preserved&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">53 &#40;73&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;48&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;97&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;001&nbsp;\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
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                      "titulo" => "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure"
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                          "autores" => array:6 [
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                            3 => "R&#46;S&#46; Gardner"
                            4 => "A&#46; Baumbach"
                            5 => "M&#46; B&#246;hm"
                          ]
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                    ]
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                    0 => array:1 [
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                        "tituloSerie" => "Eur Heart J&#46;"
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                        "paginaInicial" => "3599"
                        "paginaFinal" => "3726"
                      ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Research priorities for heart failure with preserved ejection fraction&#58; national heart&#44; lung&#44; and blood institute working group summary"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "D&#46;W&#46; Kitzman"
                            3 => "A&#46;D&#46; McCulloch"
                            4 => "B&#46;C&#46; Blaxall"
                            5 => "R&#46; Agarwal"
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                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2020"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32202936"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prevalence of heart failure in the Spanish general population aged over 45 years&#46; The PRICE Study"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "E&#46; de Teresa Galv&#225;n"
                            3 => "M&#46; Jim&#233;nez Navarro"
                            4 => "L&#46; Alonso- Pulp&#243;n"
                            5 => "J&#46; Mu&#241;iz Garc&#237;a"
                          ]
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                      "doi" => "10.1016/s1885-5857(09)60007-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2008"
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                        "paginaInicial" => "1041"
                        "paginaFinal" => "1049"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18817680"
                            "web" => "Medline"
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                      "titulo" => "The progression of hypertensive heart disease"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS One&#46;"
                        "fecha" => "2021"
                        "volumen" => "16"
                      ]
                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure and heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;C&#46; Oh"
                            1 => "H&#46;J&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Clin Hypertens&#46;"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electrophysiological manifestations of cardiac amyloidosis&#58; <span class="elsevierStyleItalic">JACC&#58; CardioOncology</span> State-of-the-Art Review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Hartnett"
                            1 => "W&#46; Jaber"
                            2 => "M&#46; Maurer"
                            3 => "B&#46; Sperry"
                            4 => "M&#46; Hanna"
                            5 => "P&#46; Collier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JACC Cardio Oncol&#46;"
                        "fecha" => "2021"
                        "volumen" => "3"
                        "paginaInicial" => "506"
                        "paginaFinal" => "515"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation&#58; hypertension as a causative agent&#44; risk factor for complications&#44; and potential therapeutic target"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;S&#46; Healey"
                            1 => "S&#46;J&#46; Conolly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9149(03)00227-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2003"
                        "volumen" => "91"
                        "paginaInicial" => "9G"
                        "paginaFinal" => "14G"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12781903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in racial&#47;ethnic and nativity disparities in cardiovascular health among adults without prevalent cardiovascular disease in the United States&#44; 1988 to 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;F&#46; Brown"
                            1 => "L&#46;J&#46; Liang"
                            2 => "S&#46;D&#46; Vassar"
                            3 => "J&#46;J&#46; Escarce"
                            4 => "S&#46;S&#46; Merkin"
                            5 => "E&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/M17-0996"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2018"
                        "volumen" => "168"
                        "paginaInicial" => "541"
                        "paginaFinal" => "549"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29554692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myocardial hypertrophy and its role in heart failure with preserved ejection fraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;R&#46; Heinzel"
                            1 => "F&#46; Hohendanner"
                            2 => "G&#46; Jin"
                            3 => "S&#46; Sedej"
                            4 => "F&#46; Edelmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/japplphysiol.00374.2015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "2015"
                        "volumen" => "119"
                        "paginaInicial" => "1233"
                        "paginaFinal" => "1242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26183480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac amyloidosis&#58; the heart of the matter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Perfetto"
                            1 => "F&#46; Cappelli"
                            2 => "F&#46; Bergesio"
                            3 => "G&#46; Ciuti"
                            4 => "M&#46;C&#46; Porciani"
                            5 => "L&#46; Padeletti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11739-011-0647-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Emerg Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "191"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21739229"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transthyretin amyloidosis and the kidney"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Lobato"
                            1 => "A&#46; Rocha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.08720811"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol&#46;"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "1337"
                        "paginaFinal" => "1346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22537653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal function in patients with hypertension associated congestive cardiac failure seen in a tertiary hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;U&#46; Osuji"
                            1 => "C&#46;U&#46; Nwaneli"
                            2 => "B&#46;J&#46; Onwubere"
                            3 => "E&#46;I&#46; Onwubuya"
                            4 => "G&#46;I&#46; Ahaneku"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Nephrol&#46;"
                        "fecha" => "2012"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of transthyretin cardiomyocyte toxicity inhibition by resveratrol analogs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Bourgault"
                            1 => "S&#46; Choi"
                            2 => "J&#46;N&#46; Buxbaum"
                            3 => "J&#46;W&#46; Kelly"
                            4 => "J&#46;L&#46; Price"
                            5 => "N&#46; Reixach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbrc.2011.04.133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biochem Biophys Res Commun&#46;"
                        "fecha" => "2011"
                        "volumen" => "410"
                        "paginaInicial" => "707"
                        "paginaFinal" => "713"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21557933"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac sympathetic denervation in wild-type transthyretin amyloidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Gimelli"
                            1 => "A&#46; Aimo"
                            2 => "G&#46; Vergaro"
                            3 => "D&#46; Genovesi"
                            4 => "V&#46; Santonato"
                            5 => "A&#46; Kusch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/13506129.2020.1769059"
                      "Revista" => array:6 [
                        "tituloSerie" => "Amyloid&#46;"
                        "fecha" => "2020"
                        "volumen" => "27"
                        "paginaInicial" => "237"
                        "paginaFinal" => "243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32441155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deposition of transthyretin in early stages of familial amyloidotic polyneuropathy&#58; evidence for toxicity of nonfibrillar aggregates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;M&#46; Sousa"
                            1 => "I&#46; Cardoso"
                            2 => "R&#46; Fernandes"
                            3 => "A&#46; Guimar&#227;es"
                            4 => "M&#46;J&#46; Saraiva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9440(10)63050-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Pathol&#46;"
                        "fecha" => "2001"
                        "volumen" => "159"
                        "paginaInicial" => "1993"
                        "paginaFinal" => "2000"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11733349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familial amyloid polyneuropathy&#58; receptor for advanced glycation end products-dependent triggering of neuronal inflammatory and apoptotic pathways"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Sousa"
                            1 => "S&#46; Du Yan"
                            2 => "R&#46; Fernandes"
                            3 => "A&#46; Guimar&#227;es"
                            4 => "D&#46; Stern"
                            5 => "M&#46;J&#46; Saraiva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1523/JNEUROSCI.21-19-07576.2001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosci"
                        "fecha" => "2001"
                        "volumen" => "21"
                        "paginaInicial" => "7576"
                        "paginaFinal" => "7586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11567048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alteraciones electrocardiogr&#225;ficas y necesidad de marcapasos en amiloidosis cardiaca&#58; an&#225;lisis de 58 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Pericet Rodriguez"
                            1 => "J&#46; L&#243;pez Aguilera"
                            2 => "C&#46; Dur&#225;n Torralba"
                            3 => "J&#46;C&#46; Castillo Dom&#237;nguez"
                            4 => "M&#46; Ruiz Ortiz"
                            5 => "J&#46; Perea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;&#46;"
                        "fecha" => "2022"
                        "volumen" => "159"
                        "paginaInicial" => "178"
                        "paginaFinal" => "184"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac amyloidosis&#58; the great pretender"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Rapezzi"
                            1 => "M&#46; Lorenzini"
                            2 => "S&#46; Longhi"
                            3 => "A&#46; Milandri"
                            4 => "C&#46; Gagliardi"
                            5 => "I&#46; Bartolomei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10741-015-9480-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Fail Rev&#46;"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "117"
                        "paginaFinal" => "124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pseudoinfarctions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;O&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2001"
                        "volumen" => "103"
                        "paginaInicial" => "e69"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse myocardial fibrosis reduces electrocardiographic voltage measures of left ventricular hypertrophy independent of left ventricular mass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Maanja"
                            1 => "B&#46; Wieslander"
                            2 => "T&#46;T&#46; Schlegel"
                            3 => "L&#46; Bacharova"
                            4 => "H&#46; Abu Daya"
                            5 => "Y&#46; Fridman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Am Heart Assoc&#46;"
                        "fecha" => "2017"
                        "volumen" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Gonz&#225;lez-L&#243;pez"
                            1 => "M&#46; Gallego-Delgado"
                            2 => "G&#46; Guzzo-Merello"
                            3 => "F&#46;J&#46; de Haro-Del Moral"
                            4 => "M&#46; Cobo- Marcos"
                            5 => "C&#46; Robles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehv338"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2015"
                        "volumen" => "36"
                        "paginaInicial" => "2585"
                        "paginaFinal" => "2594"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26224076"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "When and how do patients with cardiac amyloidosis die&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Escher"
                            1 => "M&#46; Senoner"
                            2 => "J&#46; Doerler"
                            3 => "M&#46;M&#46; Zaruba"
                            4 => "M&#46; Messner"
                            5 => "C&#46; Mussner-Seeber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Res Cardiol&#46;"
                        "fecha" => "2020"
                        "volumen" => "109"
                        "paginaInicial" => "78"
                        "paginaFinal" => "88"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospitalisation in patients with heart failure with preserved ejection fraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Nanayakkara"
                            1 => "H&#46;C&#46; Patel"
                            2 => "D&#46;M&#46; Kaye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Med Insights Cardiol&#46;"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
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