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ORIGINAL
Papel del aumento de la rigidez arterial central en el daño macro y microvascular en pacientes con enfermedad coronaria
Role of increased central arterial stiffness in macro and microvascular damage in patients with coronary artery disease
Juan Carlos Hidalgo-Santiagoa, Jesús Oneto-Oterob, Alfredo Michán-Doñac,d, Pablo Gomez-Fernándeze,
Autor para correspondencia
pgomezf@senefro.org

Autor para correspondencia.
a Centro de Salud San Telmo, Jerez, España
b Servicio de Cardiología, Hospital Universitario de Jerez, Jerez, España
c Departamento de Medicina, Hospital Universitario de Jerez, Jerez, España
d Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
e Unidad de Factores de Riesgo Vascular, Hospital Universitario de Jerez, Jerez, España
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">A-C&#41; Correlaci&#243;n de FGe con la edad y par&#225;metros de rigidez arterial &#40;Vp<span class="elsevierStyleInf">c-f</span>&#58; velocidad de pulso car&#243;tida radial&#41; y cociente Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#46; D-I&#41; Correlaci&#243;n de log alb&#46;&#47;creat&#46; con par&#225;metros arteriales&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">alb&#46;&#47;creat&#46;&#58; alb&#250;mina&#47;creatinina en orina&#59; FGe&#58; filtrado glomerular estimado&#59; PASb&#58; presi&#243;n arterial sist&#243;lica braquial&#59; PASc&#58; presi&#243;n arterial sist&#243;lica central&#59; PPb&#58; presi&#243;n de pulso braquial&#59; PPc&#58; presi&#243;n de pulso central&#59; Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#58; velocidad de pulso car&#243;tida-femoral&#47;velocidad de pulso car&#243;tida-radial&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tanto la enfermedad coronaria &#40;EC&#41; como la enfermedad renal cr&#243;nica &#40;ERC&#41; tienen una elevada prevalencia<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Es frecuente la asociaci&#243;n de alteraciones cardiacas y renales&#46; Los pacientes con enfermedad cardiovascular &#40;ECV&#41; presentan&#44; con gran frecuencia&#44; disfunci&#243;n renal<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">3</span></a>&#44; y los que tienen cualquier manifestaci&#243;n de ERC ya sea disminuci&#243;n del filtrado glomerular &#40;FG&#41; y&#47;o aumento de excreci&#243;n urinaria de alb&#250;mina tienen m&#225;s riesgo de ECV<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">4</span></a>&#46; Es tal la consistencia de esta asociaci&#243;n&#44; que se ha consolidado el t&#233;rmino &#171;s&#237;ndrome cardio-renal&#187; para definir las alteraciones cardiacas secundarias a la disfunci&#243;n renal y las anomal&#237;as renales derivadas de problemas cardiacos&#44; o a la disfunci&#243;n de ambos &#243;rganos por una causa com&#250;n<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La interrelaci&#243;n cardiopat&#237;a-nefropat&#237;a puede deberse a varios hechos&#46; Ambas pueden ser el resultado del efecto de factores de riesgo vascular tradicionales comunes &#40;envejecimiento&#44; hipertensi&#243;n arterial &#91;HTA&#93;&#44; diabetes mellitus &#91;DM&#93;&#44; dislipemia&#44; entre otros&#41;&#46; Por otra parte&#44; en la ERC moderada-severa con descenso del FG&#44; se generan factores de riesgo no tradicionales &#40;estr&#233;s oxidativo&#44; mediadores proinflamatorios&#44; alteraciones del metabolismo fosfoc&#225;lcico&#44; entre otros&#41; que pueden inducir alteraciones cardiovasculares &#40;CV&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">4</span></a>&#46; En presencia de cardiopat&#237;a&#44; tambi&#233;n puede haber mediadores proinflamatorios y est&#237;mulos neurohormonales que promueven la disfunci&#243;n renal<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uno de los mecanismos patog&#233;nicos que puede subyacer en el da&#241;o conjunto cardiaco y renal es el deterioro estructural y funcional de las grandes arterias&#46; Tanto los factores de riesgo vascular tradicionales&#44; como los fen&#243;menos generados por la disfunci&#243;n cardiaca y renal pueden contribuir a la arterio y aterosclerosis vascular con aumento de la rigidez arterial y alteraciones hemodin&#225;micas secundarias con incremento de la carga puls&#225;til&#44; lo que puede coadyuvar al da&#241;o cardiaco y renal<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">4&#8211;7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo fue estudiar el posible papel de las alteraciones de la funci&#243;n y rigidez de la aorta en la presencia y extensi&#243;n de lesiones coronarias&#44; y en la funci&#243;n renal en un grupo de enfermos con sospecha de EC en los que se realiz&#243; coronariograf&#237;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se estudiaron 48 sujetos que ingresaron de forma programada para la realizaci&#243;n de coronariograf&#237;a&#44; prescrita por un cardi&#243;logo&#44; por probable EC con base en la edad&#44; el sexo&#44; los s&#237;ntomas y otros test cardiacos&#46; Se excluyeron del estudio los pacientes ingresados por s&#237;ndrome coronario agudo&#46; Pod&#237;an ser incluidas personas con infarto de miocardio y&#47;o revascularizaci&#243;n que hubieran sucedido al menos un a&#241;o antes del estudio&#46; Todos los pacientes dieron su consentimiento informado para efectuar la coronariograf&#237;a y otras medidas hemodin&#225;micas arteriales no invasivas&#44; as&#237; como para las determinaciones de laboratorio&#46; El estudio cumpli&#243; todos los criterios &#233;ticos de la instituci&#243;n donde se ha llevado a cabo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Antes de la realizaci&#243;n de la coronariograf&#237;a y en ayunas&#44; se obtuvo sangre para la determinaci&#243;n de los par&#225;metros de laboratorio &#40;hemoglobina&#44; creatinina&#44; perfil lip&#237;dico&#44; marcadores de inflamaci&#243;n&#44; &#225;cido &#250;rico&#44; glucemia&#44; &#237;ndice <span class="elsevierStyleItalic">homeostasis model assessment insulin resistence</span> &#40;HOMA-IR&#41;&#46; La funci&#243;n renal de los pacientes se evalu&#243; mediante el filtrado glomerular estimado &#40;FGe&#41;&#44; obtenido por la f&#243;rmula <span class="elsevierStyleItalic">Chronic Kidney Disease Epidimiology Collaboration</span> &#40;CKD-EPI&#41;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">8</span></a> y la determinaci&#243;n del cociente alb&#250;mina&#47;creatinina en la primera orina de la ma&#241;ana&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Estudios hemodin&#225;micos no invasivos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Doce horas antes de la realizaci&#243;n de la coronariograf&#237;a&#44; tras 15 minutos en reposo en dec&#250;bito supino&#44; se tomaba la presi&#243;n arterial &#40;PA&#41; braquial &#40;PAb&#41; &#40;media de tres determinaciones&#41; mediante un Omron M3 IT &#40;Omron electr&#243;nica Iberia S&#46;A&#46;U&#46; Madrid&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para la determinaci&#243;n de la PA central &#40;PAc&#41; se us&#243; el mismo brazo que el de la PAb&#46; La onda de pulso se obtuvo en la arteria radial mediante tonometr&#237;a de aplanamiento usando un microman&#243;metro &#40;Millar instruments&#41; conectado a un dispositivo SphygmoCor &#40;AtCor Medical&#44; Sydney&#44; Australia&#41;&#46; Para la calibraci&#243;n del sistema&#44; se usaron los valores de PAb&#46; El dispositivo capta una serie de ondas durante 10 segundos&#59; estas son digitalizadas a 128 Hz y ensambladas en una onda promedio&#46; Para convertir la onda de presi&#243;n radial en presi&#243;n a&#243;rtica &#40;central&#41; el sistema usa una funci&#243;n de transferencia&#46; Solo se aceptaron los registros con un &#237;ndice de calidad&#44; dado por el propio dispositivo&#44; superior al 85&#37;&#46; Se consider&#243; como valor de los par&#225;metros centrales&#44; el promedio de los derivados de dos registros con buen &#237;ndice de calidad&#46; De la onda de presi&#243;n central se obtuvieron la presi&#243;n sist&#243;lica central &#40;PASc&#41;&#44; la presi&#243;n arterial diast&#243;lica central &#40;PADc&#41;&#44; la presi&#243;n arterial media central &#40;PAMc&#41;&#44; la presi&#243;n de pulso central &#40;PPc&#41; &#40;diferencia entre PASc y PADc&#41; y el &#237;ndice de aumento &#40;IA&#41; &#40;diferencia entre el primer y segundo pico sist&#243;lico&#41; que se expresa como porcentaje de la PPc&#46; Dado que el IA es influenciado por la frecuencia cardiaca &#40;FC&#41;&#44; el sistema aporta el valor de IA normalizado a una FC de 75 L&#47;m &#40;IA<span class="elsevierStyleInf">75</span>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para la determinaci&#243;n de la velocidad de pulso car&#243;tida-femoral &#40;Vp<span class="elsevierStyleInf">c-f</span>&#41; se emple&#243; el mismo dispositivo SphygmoCor&#46; La onda de pulso se obtuvo por tonometr&#237;a de aplanamiento de forma secuencial sobre la car&#243;tida com&#250;n y la arteria femoral&#46; El tiempo del recorrido entre los dos puntos arteriales se calcul&#243; a partir de la diferencia entre la onda R del registro electrocardiogr&#225;fico simult&#225;neo y el inicio de la onda de pulso en los respectivos sitios arteriales&#46; La distancia entre los dos puntos arteriales se midi&#243; cuidadosamente con una cinta m&#233;trica&#44; substrayendo la distancia entre el punto carot&#237;deo y la escotadura yugular del manubrio esternal de la distancia entre esta &#250;ltima y el punto femoral&#46; La Vp<span class="elsevierStyleInf">c-f</span> se calcul&#243; de la distancia recorrida por la onda de pulso &#40;m&#41; dividida por el tiempo de retraso &#40;s&#41; entre los dos puntos arteriales&#46; As&#237; la Vp<span class="elsevierStyleInf">c-f</span> es expresada como metros&#47;segundo &#40;m&#47;s&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los valores de Vp<span class="elsevierStyleInf">c-f</span> resultantes se compararon con los de referencia de la Sociedad Europea de Cardiolog&#237;a &#40;SEC&#41;&#44; observados en 16&#46;867 sujetos&#44; que tienen en cuenta la edad y la PA&#44; y que usan los valores de Vp<span class="elsevierStyleInf">c-f</span> obtenidos mediante la medici&#243;n directa de la distancia entre la arteria car&#243;tida y femoral<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">9</span></a>&#46; Por ello&#44; la distancia sustra&#237;da usada por nuestro m&#233;todo&#44; se convirti&#243; en distancia directa por medio de la ecuaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">10</span></a>&#58; distancia directa &#61; &#40;0&#44;45 x distancia sustra&#237;da&#41; &#43; &#40;0&#44;21 x altura&#41; &#43; 0&#44;08&#46; Dado que el uso de la distancia directa sobreestima la Vp<span class="elsevierStyleInf">c-f</span> &#40;cuando se obtiene por m&#233;todos invasivos o resonancia magn&#233;tica &#91;RM&#93;&#41;&#44; el valor de Vp<span class="elsevierStyleInf">c-f</span> se multiplic&#243; por 0&#44;8<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">11</span></a>&#46; De la Vp<span class="elsevierStyleInf">c-f</span> resultante y la Vp<span class="elsevierStyleInf">c-f</span> de referencia se obtuvo el &#237;ndice de la Vp<span class="elsevierStyleInf">c-f</span>&#44; seg&#250;n la SEC &#40;iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">sec</span>&#41; &#61; &#40;Vp<span class="elsevierStyleInf">c-f</span> medida &#8211; Vp<span class="elsevierStyleInf">c-f</span> de referencia&#41; &#247; &#40;Vp<span class="elsevierStyleInf">c-f</span> referencia&#41; x 100&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tambi&#233;n se calculo el &#237;ndice te&#243;rico de Vp<span class="elsevierStyleInf">c-f</span> &#40;iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">te&#243;rico</span>&#41; que considera otras variables &#40;edad&#44; sexo&#44; PA y FC&#41; que influyen en la Vp<span class="elsevierStyleInf">c-f</span>&#46; iVp<span class="elsevierStyleInf">c-f</span> &#61; &#40;Vp<span class="elsevierStyleInf">c-f</span> medida &#8211; Vp<span class="elsevierStyleInf">c-f</span> te&#243;rica&#41; &#247; &#40;Vp<span class="elsevierStyleInf">c-f</span> te&#243;rica&#41; x 100&#44; donde Vp<span class="elsevierStyleInf">c-f</span> te&#243;rica &#40;m&#47;s&#41; &#61; &#40;0&#44;0793 x edad&#41; &#43; &#40;0&#44;0427 x PAM &#91;presi&#243;n arterial media&#93;&#41; &#8211; &#40;0&#44;0014 x per&#237;odo cardiaco &#91;ms&#93;&#41; &#8211; &#40;0&#44;415 x sexo&#41; &#43; 2&#44;934 &#40;sexo &#61; 1 hombre&#59; 2 mujer&#41;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Usando la misma t&#233;cnica &#40;salvo los puntos para determinar la distancia&#41;&#44; se determin&#243; la velocidad de pulso car&#243;tida-radial &#40;Vp<span class="elsevierStyleInf">c-r</span>&#41; como expresi&#243;n de la rigidez de arterias musculares perif&#233;ricas&#46; Se calcul&#243; la relaci&#243;n Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span> para valorar el gradiente de rigidez arterial central&#47;perif&#233;rica<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La tonometr&#237;a para la determinaci&#243;n de la hemodin&#225;mica central&#44; la Vp<span class="elsevierStyleInf">c-f</span> y la Vp<span class="elsevierStyleInf">c-r</span> fue realizada siempre por el mismo investigador &#40;PGF&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Coronariograf&#237;a</span><p id="par0070" class="elsevierStylePara elsevierViewall">Despu&#233;s de 12 a 14 horas del ingreso hospitalario&#44; en todos los pacientes se realiz&#243; la coronariograf&#237;a por v&#237;a radial o femoral&#46; Todos los angiogramas eran visualizados por un cardi&#243;logo-hemodinamista experto &#40;JOO&#41; que desconoc&#237;a los resultados de los estudios hemodin&#225;micos no invasivos&#46; Se defini&#243; como EC significativa la existencia de&#44; al menos&#44; una lesi&#243;n con una estenosis &#8805; 60&#37;&#46; La extensi&#243;n de la EC se defini&#243; por el n&#250;mero de arterias con obstrucci&#243;n significativa&#44; considerando las tres arterias coronarias mayores&#58; descendente anterior izquierda&#44; circunfleja y arteria coronaria derecha&#46; La lesi&#243;n significativa en el tronco coronario izquierdo se consider&#243; como afecci&#243;n de dos arterias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se expresan como frecuencias absolutas y relativas&#46; Las variables cuantitativas como media &#177; desviaci&#243;n est&#225;ndar o como mediana &#40;rango intercuart&#237;lico &#91;RIQ&#93;&#41;&#44; dependiendo de la distribuci&#243;n seg&#250;n el test de Shapiro-Wilk&#46; En algunos casos&#44; las variables no normalmente distribuidas fueron convertidas en sus logaritmos&#46; La comparaci&#243;n de las variables cualitativas entre los grupos se hizo mediante el test <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&#46; Para contrastar las variables continuas normalmente distribuidas se us&#243; el an&#225;lisis de la varianza &#40;ANOVA&#41; con la prueba de Tukey para comparaciones m&#250;ltiples post hoc&#46; Para las variables sin distribuci&#243;n normal&#44; se emple&#243; el test de Kruskal-Wallis&#46; El an&#225;lisis de la relaci&#243;n entre las variables se hizo mediante el coeficiente de correlaci&#243;n de Pearson o Sperman seg&#250;n la distribuci&#243;n de estas&#46; La relaci&#243;n independiente entre variables se investig&#243; mediante regresi&#243;n lineal m&#250;ltiple&#44; seleccionando las covariables potenciales que demostraban previamente correlaci&#243;n significativa&#46; Para evaluar los efectos independientes de los par&#225;metros de rigidez arterial en el riesgo de tener EC&#44; se us&#243; la regresi&#243;n log&#237;stica por pasos&#46; Se consider&#243; significativo un valor de p &#60; 0&#44;05&#46; Todos los an&#225;lisis estad&#237;sticos se realizaron con el programa estad&#237;stico IBM SPSS statistics versi&#243;n 25 para Windows&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La edad media de los sujetos estudiados fue 61 &#177; nueve a&#241;os&#44; 64&#37; eran varones&#46; De los 48 pacientes&#44; 11&#40;23&#37;&#41; no ten&#237;an lesiones coronarias significativas &#40;grupo I&#41;&#44; 24 &#40;50&#37;&#41; evidenciaron lesiones significativas en una o dos arterias coronarias &#40;grupo II&#41; y 13 &#40;27&#37;&#41; en &#8805; tres arterias &#40;grupo III&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; No hubo diferencias significativas entre los tres grupos con respecto a la edad&#44; sexo&#44; prevalencia de HTA&#44; DM2&#44; tabaquismo ni insuficiencia renal&#46; El porcentaje de pacientes del grupo III que recib&#237;an terapia con nitratos era superior al de los otros grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">No se observaron diferencias significativas intergrupos en el perfil lip&#237;dico&#44; FGe&#44; marcadores de inflamaci&#243;n ni resistencia a la insulina&#46; La excreci&#243;n de albuminuria&#44; sin embargo&#44; fue significativamente m&#225;s elevada en el grupo III &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Solo cuatro sujetos del grupo II y cinco del grupo III ten&#237;an valores de albumina&#47;creatinina &#8805; 30 mg&#47;g&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Relaci&#243;n entre Vp<span class="elsevierStyleInf">c-f</span> y valores derivados de presi&#243;n arterial</span><p id="par0090" class="elsevierStylePara elsevierViewall">La Vp<span class="elsevierStyleInf">c-f</span> se correlacionaba directa y significativamente con la edad&#44; la presi&#243;n arterial sist&#243;lica braquial &#40;PASb&#41;&#44; la presi&#243;n de pulso braquial &#40;PPb&#41;&#44; PASc&#44; la PPc y el IA<span class="elsevierStyleInf">75</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Solo la PPc y la edad fueron predictores significativos de la Vp<span class="elsevierStyleInf">c-f</span> &#40;coeficiente regresi&#243;n &#177; ES&#58; 0&#44;09 &#177; 0&#44;01&#59; &#223; estandarizado&#58; 0&#44;72&#44; p&#58; 0&#44;000 y 0&#44;76 &#177; 0&#44;02&#59; &#223;&#58; 0&#44;35&#44; p&#58; 0&#44;000&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Relaci&#243;n entre par&#225;metros de funci&#243;n arterial y enfermedad coronaria</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los par&#225;metros de funci&#243;n arterial en los tres grupos se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Tanto la PASb como la PASc fueron cuantitativamente m&#225;s elevadas en los grupos con mayor EC&#44; aunque sin alcanzar significaci&#243;n estad&#237;stica&#46; El grupo con EC m&#225;s severa ten&#237;a valores de PPb y la PPc mucho m&#225;s m&#225;s altos que el grupo sin EC&#46; La Vp<span class="elsevierStyleInf">c-f</span> y los &#237;ndices de Vp<span class="elsevierStyleInf">c-f</span> aumentaban de forma progresiva y significativa con el grado de EC&#46; No hubo diferencias entre los grupos en la Vp<span class="elsevierStyleInf">c-r</span>&#44; pero el gradiente de rigidez arterial central&#47;rigidez arterial perif&#233;rica &#40;Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#41; fue mayor en el grupo III&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Tras el ajuste a covariables como la edad&#44; el sexo&#44; el tabaquismo&#44; PAM&#44; lipoprote&#237;na de baja densidad &#40;LDL-c&#41;&#44; DM2 y CKD-EPI&#44; la VP<span class="elsevierStyleInf">c-f</span> predec&#237;a de forma independiente la presencia de EC&#46; El riesgo relativo de EC aumentaba 2&#44;5 veces por cada metro de incremento de la Vp<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Pese a que la PPc elevaba el riesgo de EC&#44; este efecto desaparec&#237;a cuando se incorporaba en el modelo la Vp<span class="elsevierStyleInf">c-f</span>&#46; Tanto el iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">te&#243;rico</span> como el iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">sec</span> predec&#237;an de forma independiente la EC&#44; pero con menor potencia que la Vp<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Relaci&#243;n entre par&#225;metros de funci&#243;n arterial y la funci&#243;n renal</span><p id="par0105" class="elsevierStylePara elsevierViewall">En el an&#225;lisis conjunto de todos los pacientes&#44; el FGe se correlacionaba de forma negativa y significativa con la edad &#40;r&#58; -623&#44; p&#58; 0&#44;000&#41;&#44; la Vp<span class="elsevierStyleInf">c-f</span> &#40;r&#58; -314&#44; p&#58; 0&#44;03&#41; y el cociente Vp<span class="elsevierStyleInf">c-f</span> &#47;Vp<span class="elsevierStyleInf">c-r</span> &#40;r&#58; -399&#44; p&#58; 0&#44;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Exist&#237;a una correlaci&#243;n positiva significativa entre albuminuria y PASb &#40;r&#58; 0&#44;314&#44; p&#58; 0&#44;03&#41;&#44; PPb &#40;r&#58; 0&#44;305&#44; p&#58; 0&#44;03&#41;&#44; PASc &#40;r&#58; 0&#44;310&#44; p&#58; 0&#44;03&#41;&#44; PPc &#40;r&#58; 0&#44;305&#44; p&#58; 0&#44;03&#41; y la Vp<span class="elsevierStyleInf">c-f</span> &#40;r&#58; 0&#44;294&#44; p&#58; 0&#44;04&#41; y el cociente Vp<span class="elsevierStyleInf">c-f</span> &#47; Vp<span class="elsevierStyleInf">c-r</span> &#40;r&#58; 0&#44;314&#59; p&#58; 0&#44;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de regresi&#243;n lineal m&#250;ltiple&#44; el poder predictor significativo de la Vp<span class="elsevierStyleInf">c-f</span> sobre el FGe se extingu&#237;a cuando se incorporaba en el modelo la edad que s&#237; era predictora independiente del FGe&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La Vp<span class="elsevierStyleInf">c-f</span> se asociaba a la albuminuria &#40;&#223;&#58; 0&#44;29&#44; p&#58; 0&#44;04&#41;&#44; pero la relaci&#243;n desaparec&#237;a cuando en el modelo se introduc&#237;an los par&#225;metros arteriales condicionados por el aumento de la rigidez arterial &#40;PASb&#44; PASc&#44; PPb y Pc&#41; que s&#237; ten&#237;an capacidad predictora de la albuminuria&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El gradiente Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span> se asociaba a la albuminuria independientemente de la PASb&#44; PASc&#44; PPb y PPc &#40;coeficiente &#223;&#58; 0&#44;31&#44; p&#58; 0&#44;03&#41;&#46; La capacidad predictora de estos desaparec&#237;a cuando en el modelo se incorporaba el gradiente de rigidez&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Relaci&#243;n entre funci&#243;n arterial y el combinado enfermedad coronaria &#40;EC&#41;-enfermedad renal &#40;ER&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Para estudiar esta relaci&#243;n se defini&#243; como ER la presencia de un FG &#60; 60 mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y&#47;o un cociente de alb&#250;mina&#47;creatinina en orina &#8805; 30 mg&#47;g&#46; Se definieron cuatro grupos&#58; ausencia de EC y de ER &#40;EC-&#47;ER-&#41;&#59; presencia de EC y ausencia de ER &#40;EC&#43;&#47;ER-&#41;&#59; ausencia de EC y presencia de ER &#40;EC-&#47;ER&#43;&#41;&#59; presencia de EC y de ER &#40;EC&#43;&#47;ER&#43;&#41;&#46; La Vp<span class="elsevierStyleInf">c-f</span> en los grupos con EC&#43;&#47;ER&#43; &#40;n&#58; 12&#41; &#40;11&#44;1 &#177; 1&#44;6 m&#47;s&#41; y EC&#43;&#47;ER- &#40;n&#58; 25&#41; &#40;9&#44;9 &#177; 1&#44;4 m&#47;s&#41; fue significativamente mayor &#40;p&#58; 0&#44;000&#41; que la del grupo EC-&#47;ER- &#40;n&#58; 9&#41; &#40;6&#44;9 &#177; 1&#44;7 m&#47;s&#41;&#46; La Vp<span class="elsevierStyleInf">c-f</span> en el grupo EC-&#47;ER&#43; fue cuantitativamente superior &#40;9&#44;5 &#177; 0&#44;4&#41; que la del grupo EC-&#47;ER-&#44; pero la escasa representaci&#243;n num&#233;rica de este &#40;n&#58; 2&#41; no permite comparaciones estad&#237;sticas&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">El principal hallazgo de nuestro estudio es que en un grupo de pacientes con sospecha de EC estable remitidos para coronariograf&#237;a&#44; la Vp<span class="elsevierStyleInf">c-f</span> es mayor cuanto m&#225;s extensa es la EC y&#44; adem&#225;s&#44; predice de forma independiente la presencia de lesiones coronarias significativas&#46; Por otra parte&#44; en pacientes con EC&#44; el aumento de la Vp<span class="elsevierStyleInf">c-f</span> y del gradiente de rigidez central&#47;rigidez perif&#233;rica tambi&#233;n puede contribuir al descenso del FGe y al incremento de la albuminuria inducidos&#44; respectivamente&#44; por la edad y por los par&#225;metros arteriales relacionados con el aumento de rigidez central &#40;PAS y PP braquiales y centrales&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La Vp<span class="elsevierStyleInf">c-f</span> se considera el m&#233;todo de referencia para determinar la rigidez a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">14</span></a>&#46; La rigidez arterial se considera un marcador estructural y funcional que puede integrar el efecto de todos los factores de riesgo vascular tradicionales conocidos y es un predictor de mortalidad y de eventos CV<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; la Vp<span class="elsevierStyleInf">c-f</span> no indexada fue significa y progresivamente mayor en los sujetos con mayor extensi&#243;n de EC&#46; Es de destacar que esto ocurri&#243;&#44; pese a que el grupo III&#44; con lesi&#243;n en tres o m&#225;s arterias&#44; era el que recib&#237;a mayor tratamiento con nitratos que pueden disminuir la rigidez arterial<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Dado que la edad&#44; el sexo y la PA son importantes determinantes de la Vp<span class="elsevierStyleInf">c-f</span>&#44; usamos el iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">te&#243;rico</span> y el iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">sec</span> que integran estos factores para valorar el efecto predictivo independiente de la rigidez a&#243;rtica sobre la presencia de EC&#46; Aunque el riesgo disminu&#237;a en relaci&#243;n con el obtenido cuando se consideraba la Vp<span class="elsevierStyleInf">c-f</span> sin indexar &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93; &#91;IC 95&#37;&#93;&#58; 1&#44;56 &#91;1&#44;04 a 2&#44;34&#93; y 2&#44;00 &#91;1&#44;00 a 4&#44;00&#41; vs&#46; 2&#44;51 &#91;1&#44;34 a 4&#44;58&#93;&#44; respectivamente&#41;&#44; persist&#237;a su valor predictivo significativo que tambi&#233;n era independiente de los otros factores de riesgo vascular tradicionales&#46; Este hecho suscita la posibilidad de que la rigidez a&#243;rtica recapitule el efecto que tiene la exposici&#243;n vascular durante tiempo a factores de riesgo tradicionales conocidos y&#44; posiblemente&#44; a otros desconocidos&#44; sobre la estructura y funci&#243;n vascular&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Otros estudios han demostrado asociaci&#243;n entre Vp<span class="elsevierStyleInf">c-f</span> y aterosclerosis coronaria y una relaci&#243;n entre Vp<span class="elsevierStyleInf">c-f</span> y la presencia y severidad de EC demostrada por coronariograf&#237;a&#44; as&#237; como su capacidad predictiva independiente de EC<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">18&#8211;22</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Son varios los mecanismos por los que el aumento de la rigidez a&#243;rtica puede inducir isquemia mioc&#225;rdica y EC&#46; Una mayor velocidad de pulso favorece el retorno precoz de la onda refleja y un mayor IA&#46; Consecuentemente&#44; se produce elevaci&#243;n de la PASc&#44; disminuci&#243;n de la PAD y aumento de la PP&#46; Como resultado de estos cambios&#44; aparecen hipertrofia cardiaca e isquemia del miocardio cuya perfusi&#243;n se produce predominantemente durante la di&#225;stole<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; En nuestro estudio&#44; observamos valores de IA<span class="elsevierStyleInf">75</span> y PASc cuantitativamente mayores en el grupo con EC que&#44; sin embargo&#44; no alcanzaron significaci&#243;n estad&#237;stica&#44; probablemente por el n&#250;mero reducido de casos&#44; y un aumento importante de la PPb y PPc en los sujetos con mayor carga de EC&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Este incremento de la pulsatilidad tambi&#233;n puede contribuir a la aterosclerosis&#46; Muchas evidencias experimentales y datos cl&#237;nicos soportan la participaci&#243;n del componente puls&#225;til de la PA en la g&#233;nesis de la aterosclerosis&#46; En animales de experimentaci&#243;n&#44; el aumento de la PP favorece la activaci&#243;n de fen&#243;menos proinflamatorios y el influjo de lipoprote&#237;nas de baja densidad oxidadas en la pared arterial<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">25</span></a>&#46; En modelos experimentales de aterosclerosis&#44; la distensi&#243;n c&#237;clica de la pared arterial estimula la proliferaci&#243;n celular y la captaci&#243;n de l&#237;pidos por la pared vascular<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">26</span></a>&#46; C&#233;lulas endoteliales sometidas a una fuerza c&#237;clica aumentan la expresi&#243;n de selectinas y mol&#233;culas de adhesi&#243;n intercelular &#40;ICAM-1&#41;&#44; la adhesi&#243;n de monocitos y la producci&#243;n de ani&#243;n super&#243;xido<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">27&#44;28</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Otros estudios han documentado que la PPc y la PPc normalizada a la PAM &#40;pulsatilidad a&#243;rtica&#41; se relacionan con la presencia y extensi&#243;n de EC incluso tras el ajuste a otros factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; Una mayor PP tambi&#233;n se asocia con enfermedad arterial perif&#233;rica independiente de la edad&#44; tabaquismo&#44; DM y dislipemia<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">31</span></a>&#46; En el presente trabajo&#44; la PPc y la PPb tambi&#233;n se mostraron como predictores de la existencia de EC&#44; independientemente de otros factores de riesgo&#46; El aumento de la pulsatilidad arterial contribuye a la aterosclerosis y esta aumenta la rigidez arterial y la PP&#44; estableci&#233;ndose as&#237; una relaci&#243;n bidireccional<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">El aumento de la rigidez arterial central propicia lesiones macrovasculares en el lecho coronario y tambi&#233;n puede inducir da&#241;o microvascular a nivel renal&#46; En nuestro estudio&#44; se evidenci&#243; una correlaci&#243;n significativa inversa del FGe con la edad y la Vp<span class="elsevierStyleInf">c-f</span>&#46; En la regresi&#243;n&#44; se observ&#243; que la Vp<span class="elsevierStyleInf">c-f</span> ten&#237;a poder predictivo del FGe&#44; sin embargo&#44; este desaperec&#237;a cuando en el modelo se incorporaba la edad&#46; Nuestros datos sugieren que el principal determinante del FGe en la poblaci&#243;n estudiada es la edad que puede ejercer su efecto delet&#233;reo sobre el FG por los cambios en la rigidez arterial inherentes al envejecimiento&#46; Es posible&#44; no obstante&#44; que la ausencia de una asociaci&#243;n independiente entre rigidez arterial y FG en nuestro estudio est&#233; condicionada por la reducida representaci&#243;n de sujetos con deterioro significativo del FG &#40;solo el 16&#37; de los pacientes estudiados ten&#237;an basalmente un FGe &#60; 60 mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">El aumento de la rigidez y de la presi&#243;n puls&#225;til a&#243;rticas inherente al envejecimiento o potenciado por la presencia de factores de riesgo vascular condiciona cambios estructurales y hemodin&#225;micos a nivel microvascular renal que pueden producir isquemia y descenso del FG&#46; Se ha demostrado una asociaci&#243;n positiva entre el &#237;ndice de resistencia renal medido por ecograf&#237;a-doppler y la rigidez a&#243;rtica&#44; y una correlaci&#243;n negativa con el FG<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">33</span></a>&#46; As&#237;&#44; el aumento de resistencia intrarrenal no solo ser&#237;a una patolog&#237;a intr&#237;nseca renal&#44; sino que tambi&#233;n ser&#237;a una adaptaci&#243;n fisiopatol&#243;gica al incremento de la pulsatilidad vinculado con una mayor rigidez a&#243;rtica&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En los enfermos con ERC con reducci&#243;n severa del FG hay un aumento consistente de la Vp<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">34&#44;35</span></a>&#46; Sin embargo&#44; en situaci&#243;n de insuficiencia renal ligera-moderada&#44; los estudios transversales que han analizado la relaci&#243;n entre rigidez arterial a&#243;rtica y FG han aportado resultados variables&#46; En algunos&#44; se evidenci&#243; una asociaci&#243;n de las dos variables independiente de otros factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">36&#44;37</span></a>&#44; en otros&#44; la relaci&#243;n no era independiente<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">38&#8211;40</span></a> y en algunos&#44; la magnitud de la relaci&#243;n entre Vp<span class="elsevierStyleInf">c-f</span> y FG disminu&#237;a de forma considerable cuando en el modelo se incorporaba la edad &#40;OR 1&#44;38 &#91;IC 95&#37; 1&#44;33 a 1&#44;43&#93; vs&#46; 1&#44;13 &#91;IC 95&#37; 1&#44;08 a 1&#44;18&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">41</span></a>&#46; Es posible que la variabilidad de resultados dependa de las diferencias en las poblaciones estudiadas y en los m&#233;todos de determinaci&#243;n de rigidez arterial&#44; y de los distintos ajustes a covariables&#46; En otros estudios longitudinales se comprob&#243; que el aumento de la rigidez a&#243;rtica era determinante de un deterioro m&#225;s r&#225;pido del FG y de una mayor incidencia de ERC<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">40&#8211;44</span></a>&#46; As&#237;&#44; se puede concluir que el aumento de la rigidez a&#243;rtica&#44; de forma directa o como mediador de otros factores de riesgo&#44; entre ellos la edad&#44; se vincula con menor FG&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Adem&#225;s del descenso del FG&#44; otro par&#225;metro que define la ERC es la albuminuria&#46; En nuestro estudio se observa que los enfermos con mayor grado de EC eran los que presentaban mayor excreci&#243;n urinaria de alb&#250;mina&#46; Comprobamos una correlaci&#243;n directa entre albuminuria&#44; rigidez arterial y par&#225;metros de funci&#243;n arterial relacionados con aqu&#233;lla&#44; como son la PASb&#44; PASc&#44; la PPb y la PPc&#46; En el an&#225;lisis de regresi&#243;n&#44; la asociaci&#243;n significativa entre la Vp<span class="elsevierStyleInf">c-f</span> y albuminuria desaparec&#237;a cuando se inclu&#237;a en el modelo la PSb&#44; PASc&#44; PPb o la PPc&#44; lo que sugiere la mediaci&#243;n de estos en la albuminuria relacionada con el aumento de la rigidez arterial&#46; El incremento de la pulsatilidad y la trasmisi&#243;n de la PAS no amortiguada por una aorta r&#237;gida al glom&#233;rulo&#44; sobre todo en presencia de una alteraci&#243;n de la autorregulaci&#243;n renal&#44; como puede ocurrir en caso de coexistencia de nefropat&#237;a o de factores de riesgo vascular&#44; puede inducir hiperperfusi&#243;n glomerular&#44; disfunci&#243;n endotelial&#44; aumento de la permeabilidad glomerular y de la excreci&#243;n urinaria de alb&#250;mina&#44; y&#44; a largo plazo&#44; da&#241;o estructural glomerular&#46; En nuestro estudio&#44; comprobamos&#44; en el grupo con m&#225;s EC&#44; un aumento de la relaci&#243;n Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#46; Por otra parte&#44; la relaci&#243;n Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span> se correlaciona positiva y significativamente con la albuminuria y&#44; adem&#225;s&#44; mostraba una capacidad predictora independiente sobre la misma&#46; Un mayor Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span> expresar&#237;a un aumento de la rigidez aortica en relaci&#243;n con la rigidez de arterias musculares perif&#233;ricas&#46; Este incremento del gradiente de rigidez central&#47;rigidez perif&#233;rica inducir&#237;a una mayor transferencia de la energ&#237;a puls&#225;til a arterias m&#225;s peque&#241;as y a la microcirculaci&#243;n renal<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">13&#44;45</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Muchos estudios han demostrado una asociaci&#243;n entre albuminuria y la morbimortalidad CV&#44; y una relaci&#243;n entre albuminuria y presencia y severidad de EC independiente de otros factores de riesgo vascular<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">46&#8211;48</span></a>&#46; Igual que lo observado en el presente trabajo&#44; otros estudios transversales han comprobado un v&#237;nculo entre la rigidez arterial y albuminuria&#44; incluso con valores inferiores a los considerados como microalbuminuria<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">40&#44;49&#44;50</span></a>&#46; Esta observaci&#243;n es importante&#44; ya que la relaci&#243;n entre el riesgo CV y la albuminuria no es dicot&#243;mica sino cont&#237;nua<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">51</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene algunas debilidades&#58; un n&#250;mero reducido de enfermos que puede haber condicionado el poder estad&#237;stico de algunas comparaciones&#44; el car&#225;cter transversal que no permite analizar el impacto pron&#243;stico de la rigidez arterial en eventos cardiorrenales&#44; y la toma por parte de todos los enfermos de f&#225;rmacos que pueden influir en la rigidez arterial&#46; El hecho de que todos los pacientes incluidos ten&#237;an diagn&#243;stico previo de EC estable&#44; excluy&#233;ndose los eventos coronarios agudos&#44; la posibilidad de hacer an&#225;lisis de predicci&#243;n de asociaci&#243;n transversal y la ausencia de diferencias significativas entre los grupos en los medicamentos recibidos &#40;la toma de nitratos&#44; f&#225;rmacos que pueden reducir la rigidez arterial&#44; era superior en el grupo con mayor EC y con mayor rigidez a&#243;rtica&#41; pueden atenuar las limitaciones se&#241;aladas&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">El estudio tiene tambi&#233;n&#44; a nuestro entender&#44; algunas fortalezas&#58; el dise&#241;o previo a su ejecuci&#243;n&#44; la realizaci&#243;n del an&#225;lisis de la funci&#243;n arterial y de la coronariograf&#237;a por parte de dos investigadores diferentes y desconocedores de los resultados de la prueba que no efectuaban&#44; y el uso de la Vp<span class="elsevierStyleInf">c-f</span> como m&#233;todo de estudio de la rigidez a&#243;rtica&#46; Esta t&#233;cnica es reconocida como procedimiento adecuado para estudiar la relaci&#243;n entre la rigidez arterial y los eventos CV<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">52</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">De nuestro estudio se deduce una interacci&#243;n din&#225;mica entre funci&#243;n a&#243;rtica-EC&#44; y entre funci&#243;n a&#243;rtica-funci&#243;n renal&#44; y permite afirmar que el aumento de la rigidez a&#243;rtica puede constituir uno de los mecanismos subyacentes del da&#241;o macro y microvascular en la EC&#46; La comprobaci&#243;n en nuestro estudio de una Vp<span class="elsevierStyleInf">c-f</span> cuantitativa y significativamente mayor cuando se combina EC y ER refuerza esta afirmaci&#243;n&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Tambi&#233;n se derivan algunas aplicaciones para la pr&#225;ctica cl&#237;nica&#46; La determinaci&#243;n de la Vp<span class="elsevierStyleInf">c-f</span> podr&#237;a complementar a otras pruebas de estudio de isquemia mioc&#225;rdica para reducir coronariograf&#237;as innecesarias como se ha demostrado en otro trabajo<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">22</span></a>&#46; Por otra parte&#44; la Vp<span class="elsevierStyleInf">c-f</span> puede considerarse no solo como biomarcador para una mejor estratificaci&#243;n de riesgo de eventos cardiacos y renales&#44; sino tambi&#233;n como potencial diana terap&#233;utica para reducir eventos cardio-renales&#46; Diversos agentes terape&#250;ticos &#40;bloqueantes del sistema renina-angiotensina&#44; las estatinas&#44; los antialdoster&#243;nicos y los inhibidores del cotransportador sodio-glucosa &#91;iSGLT<span class="elsevierStyleInf">2</span>&#93;&#44; entre otros&#41; han demostrado capacidad para reducir la rigidez arterial a&#243;rtica<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">53&#8211;56</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusiones</span><p id="par0220" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">En pacientes sometidos a coronariograf&#237;a por sospecha de EC estable&#44; la Vp<span class="elsevierStyleInf">c-f</span>&#44; expresi&#243;n de la rigidez a&#243;rtica&#44; se asocia de forma independiente con la existencia de EC y se relaciona con su extensi&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">El aumento de la rigidez a&#243;rtica se asocia con un incremento de los par&#225;metros de la pulsatilidad arterial&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">El aumento de la rigidez arterial participa en la disminuci&#243;n del FGe que acompa&#241;a al envejecimiento y subyace como mecanismo patog&#233;nico en el aumento de la albuminuria inducido por una mayor carga puls&#225;til&#46; Esta mayor carga puls&#225;til se trasmitir&#237;a con mayor facilidad a la microcirculaci&#243;n renal debido a un aumento del gradiente de rigidez central&#47;perif&#233;rica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">En pacientes con EC&#44; el aumento de la rigidez a&#243;rtica que podr&#237;a integrar el efecto&#44; a lo largo del tiempo&#44; de factores de riesgo vascular conocidos y desco-nocidos&#44; puede constituir uno de los mecanismos subyacentes del da&#241;o macro y microvascular&#46;</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financiaci&#243;n</span><p id="par0245" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicto de intereses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Relaci&#243;n entre Vp y valores derivados de presi&#243;n arterial"
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              "titulo" => "Relaci&#243;n entre par&#225;metros de funci&#243;n arterial y enfermedad coronaria"
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              "titulo" => "Relaci&#243;n entre par&#225;metros de funci&#243;n arterial y la funci&#243;n renal"
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              "titulo" => "Relaci&#243;n entre funci&#243;n arterial y el combinado enfermedad coronaria &#40;EC&#41;-enfermedad renal &#40;ER&#41;"
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    "fechaRecibido" => "2020-12-08"
    "fechaAceptado" => "2021-02-03"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Con frecuencia&#44; los pacientes con cardiopat&#237;a tienen disfunci&#243;n renal manifestada por el descenso del filtrado glomerular &#40;FG&#41; y&#47;o aumento de la albuminuria&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue estudiar el papel del aumento de la rigidez a&#243;rtica en la presencia y extensi&#243;n de la enfermedad coronaria &#40;EC&#41; y en la disfunci&#243;n renal en sujetos con EC&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal de 48 pacientes con sospecha de EC sometidos a coronariograf&#237;a&#46; Mediante tonometr&#237;a de aplanamiento sobre la arterial radial y aplicando una funci&#243;n de transferencia&#44; se calcularon los valores de presi&#243;n arterial central&#46; El estudio de la rigidez a&#243;rtica se hizo mediante la determinaci&#243;n de la velocidad de pulso car&#243;tida-femoral &#40;Vp<span class="elsevierStyleInf">c-f</span>&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De los 48 pacientes&#44; 11 no ten&#237;an lesiones coronarias significativas&#44; 24 evidenciaron lesiones significativas en una o dos arterias coronarias y 13 en &#8805; tres arterias&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El grupo con mayor grado de EC ten&#237;a valores de presi&#243;n de pulso central &#40;PPc&#41; m&#225;s altos que el grupo sin EC&#46; La Vp<span class="elsevierStyleInf">c-f</span> aumentaba de forma progresiva y significativa con el grado de EC&#46; La regresi&#243;n log&#237;stica mostraba que la VP<span class="elsevierStyleInf">c-f</span> predec&#237;a de forma independiente la presencia de EC&#46; El FG se correlacionaba de forma negativa y significativa con la edad&#46; La Vp<span class="elsevierStyleInf">c-f</span> se asociaba a la albuminuria&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En pacientes con EC estable&#44; la Vp<span class="elsevierStyleInf">c-f</span> se relaciona de forma independiente con la existencia y extensi&#243;n de la EC&#44; as&#237; como con la disminuci&#243;n del FG y el aumento de la albuminuria&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patients with heart disease frequently have renal dysfunction manifested by a decrease in glomerular filtration rate &#40;GFR&#41; and &#47; or increase of albuminuria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The objective was to study the possible role of increased aortic stiffness in the presence and extent of coronary artery disease &#40;CAD&#41; and kidney dysfunction in a group of patients with suspected CAD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Patients and methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We studied forty-eight patients undergoing coronariography for suspected coronary disease &#40;CAD&#41;&#46; Using applanation tonometry on the radial artery and applying a transfer function&#44; central blood pressure values were calculated&#46; The study of aortic stiffness was done by determining the carotid-femoral pulse velocity &#40;Pv<span class="elsevierStyleInf">c-f</span>&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Of the 48 patients&#44; 11 had no significant coronary lesions&#44; 24 showed significant lesions in 1 or 2 coronary arteries and 13 in &#8805; 3 arteries&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The group with a higher degree of CD had significantly higher cPP values than the group without CD&#46; The Pv<span class="elsevierStyleInf">c-f</span> increased progressively and significantly with the degree of CD&#46; The logistic regression showed that Pv<span class="elsevierStyleInf">c-f</span> independently predicted the presence of CD&#46; The relative risk of CD increased 2&#46;5 times for each meter of increase in Pv<span class="elsevierStyleInf">c-f</span>&#46; The GFR was negatively and significantly correlated with age and Pv<span class="elsevierStyleInf">c-f</span> was associated with albuminuria&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In patients with stable CD&#44; Pv<span class="elsevierStyleInf">c-f</span>&#44; expression of aortic stiffness&#44; is independently associated with the existence of CD and its degree of extension&#46; The increase in arterial stiffness also participates in the decrease in GFR and in the increase in albuminuria&#46;</p></span>"
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">A-C&#41; Correlaci&#243;n de FGe con la edad y par&#225;metros de rigidez arterial &#40;Vp<span class="elsevierStyleInf">c-f</span>&#58; velocidad de pulso car&#243;tida radial&#41; y cociente Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#46; D-I&#41; Correlaci&#243;n de log alb&#46;&#47;creat&#46; con par&#225;metros arteriales&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">alb&#46;&#47;creat&#46;&#58; alb&#250;mina&#47;creatinina en orina&#59; FGe&#58; filtrado glomerular estimado&#59; PASb&#58; presi&#243;n arterial sist&#243;lica braquial&#59; PASc&#58; presi&#243;n arterial sist&#243;lica central&#59; PPb&#58; presi&#243;n de pulso braquial&#59; PPc&#58; presi&#243;n de pulso central&#59; Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span>&#58; velocidad de pulso car&#243;tida-femoral&#47;velocidad de pulso car&#243;tida-radial&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#40;1-2 arterias&#41;&nbsp;\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">&#40;&#8805; 3 arterias&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><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">Variable&nbsp;\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">&#40;n&#58;11&#41;&nbsp;\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">&#40;n&#58; 24&#41;&nbsp;\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">&#40;n&#58; 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\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">Edad &#40;a&#241;os&#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">59 &#177; 9&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">59 &#177; 9&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">66 &#177; 9&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">ns&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">Varones &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&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">75&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">77&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">ns&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">Tabaquismo &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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">58&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">38&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">ns&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">DM2&#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&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">42&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">8&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">ns&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">Historia de HTA &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&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">83&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">77&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">ns&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">Historia de revascularizaci&#243;n&#44; n&#46;&#176;&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">0&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">4&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">1&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">ns&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">FGe&#60; 60 mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> &#40;n&#46;&#176;&#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">2&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">3&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">3&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">ns&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">iECA&#47;ARA2 &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&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">50&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">46&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">ns&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">Betabloqueantes &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&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">75&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">77&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">ns&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">Calcioantagonistas &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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">25&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">8&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">ns&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">Diur&#233;ticos &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&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">21&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">15&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">ns&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">Antiagregantes &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&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">92&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">85&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">ns&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">Nitratos &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&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">25&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">61&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">1&#44;8 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&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">Hb &#40;g&#47;dL&#41; &#40;x &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#177; 1&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#177; 2&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&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">Log PCRu &#40;mg&#47;L&#41; &#40;x &#177; DE&#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">Colesterol &#40;mg&#47;dL&#41; &#40;x &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">168 &#177; 46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">170 &#177; 34&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">LDL-c &#40;mg&#47;dL&#41; &#40;x &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99 &#177; 36&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">HDL-c&#40;mg&#47;dL&#41; &#40;x &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#177; 11&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ac &#250;rico &#40;mg&#47;dL&#41; &#40;x &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;8 &#177; 3&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">ns&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">Alb&#47;creat&#46; orina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;7 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;4 &#40;19&#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">21 &#40;34&#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">I vs&#46; II&#58; ns&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">&#40;mg&#47;g&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">I vs&#46; III&#58;0&#44;003&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">&#40;mediana &#91;RIQ&#93;&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">II vs&#46; III&#58;0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2684623.png"
              ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Par&#225;metros de laboratorio</p>"
        ]
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      4 => array:8 [
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        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">IA<span class="elsevierStyleInf">75</span>&#58; &#237;ndice de aumento estandarizado a una frecuencia cardiaca de 75 L&#47;min&#46;&#59; iVP<span class="elsevierStyleInf">c-f</span>&#58;&#237;ndice Vp<span class="elsevierStyleInf">c-f</span>&#59; ns&#58; no significativo&#59; PAD&#58; presi&#243;n arterial diast&#243;lica braquial&#59; PASb&#58; presi&#243;n arterial sist&#243;lica braquial&#59; PASc&#58; presi&#243;n arterial sist&#243;lica central&#59; PPb&#58; presi&#243;n de pulso braquial&#59; PPc&#58; presi&#243;n de pulso central&#59; RIQ&#58; rango intercuart&#237;lico&#59; sec&#58; Sociedad Europea de Cardiolog&#237;a&#59; Vp<span class="elsevierStyleInf">c-f</span>&#58; velocidad de pulso car&#243;tida-femoral&#59; Vp<span class="elsevierStyleInf">c-r</span>&#58; velo-cidad de pulso car&#243;tida-radial&#59; x &#177; DE&#58; media &#177; desviaci&#243;n est&#225;ndar&#46;</p>"
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                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">Variable&nbsp;\t\t\t\t\t\t\n
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                  \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">Grupo I&nbsp;\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">Grupo II&nbsp;\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">Grupo III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PASb &#40;mmHg&#41; &#40;x &#177; DE&#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">126 &#177; 12&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">137 &#177; 22&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">141 &#177; 24&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">ns&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">PADb &#40;mmHg&#41; &#40;x &#177; DE&#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">75 &#177; 6&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">78 &#177; 12&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">69 &#177; 10&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">II vs&#46; III&#58;0&#44;03&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">PPb &#40;mmHg&#41; &#40;x &#177; DE&#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">50 &#177; 11&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">58 &#177; 15&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">72 &#177; 22&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">I vs&#46; III&#58;0&#44;007&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">PASc &#40;mmHg&#41; &#40;x &#177; DE&#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">115 &#177; 11&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">127 &#177; 21&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">129 &#177; 21&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">ns&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">PPc &#40;mmHg&#41; &#40;x &#177; DE&#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">39 &#177; 9&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">48 &#177; 13&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">60 &#177; 19&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">I vs&#46; III&#58;0&#44;004&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">IA<span class="elsevierStyleInf">75</span> &#40;&#37;&#41; &#40;x &#177; DE&#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">19 &#177; 12&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">26 &#177; 9&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">26 &#177; 9&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">ns&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">Vp<span class="elsevierStyleInf">c-f</span> &#40;m&#47;s&#41; &#40;mediana &#91;RIQ&#93;&#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">6&#44;83 &#40;3&#44;21&#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">9&#44;71&#40;2&#44;4&#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">11&#44;40&#40;1&#44;4&#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">I vs&#46; II&#58;0&#44;000&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">I vs&#46; III&#58;0&#44;000&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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">II vs&#46; III&#58;0&#44;005&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">iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">sec</span> &#40;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-17 &#40;20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;88 &#40;14&#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">3&#44;7 &#40;8&#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">I vs&#46; II&#58;0&#44;000&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">&#40;mediana &#91;RIQ&#93;&#41; II vs&#46; III&#58;ns&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">I vs&#46; III&#58;0&#44;000&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="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">te&#243;rico</span> &#40;&#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">-24 &#40;24&#44;7&#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">3 &#40;7&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I vs&#46; II&#58;0&#44;000&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">&#40;mediana &#91;RIQ&#93;&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I vs&#46; III&#58;0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">II vs&#46; III&#58;ns&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vp<span class="elsevierStyleInf">c-r</span> &#40;m&#47;s&#41; &#40;x &#177; DE&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4 &#177; 1&#44;3&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">7&#44;5 &#177; 1&#44;7&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">7&#44;3 &#177; 1&#44;3&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">ns&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">Vp<span class="elsevierStyleInf">c-f</span>&#47;Vp<span class="elsevierStyleInf">c-r</span> &#40;x &#177; DE&#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">1&#44;12 &#177; 0&#44;25&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">1&#44;36 &#177; 0&#44;35&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">1&#44;57 &#177; 0&#44;36&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">I vs&#46; III&#58;0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#59; OR&#58; odds ratio&#59; PPb&#58; presi&#243;n de pulso braquial&#59; PPc&#58; presi&#243;n de pulso central&#59; sec&#58; sociedad europea de cardiolog&#237;a&#59; Vp<span class="elsevierStyleInf">c-f</span>&#58; velocidad de pulso car&#243;tida-femoral&#59; iVp<span class="elsevierStyleInf">c-f</span>&#58; &#237;ndice de velocidad de pulso car&#243;tida-femoral&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Variable&nbsp;\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">OR&nbsp;\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">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\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">Modelo 1 incluyendo Vp<span class="elsevierStyleInf">c-f</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">2&#44;51&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">1&#44;34 - 4&#44;58&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">0&#44;004&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">y covariables<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Modelo 2 incluyendo&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">1&#44;56&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">1&#44;04 - 2&#44;34&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">0&#44;03&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">iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">te&#243;rico</span> y covariables <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Modelo 3 incluyendo&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">2&#44;00&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">1&#44;00 - 4&#44;00&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">0&#44;04&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">iVp<span class="elsevierStyleInf">c-f</span><span class="elsevierStyleInf">sec</span> y covariables <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Modelo 4 incluyendo&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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Información del artículo
ISSN: 02149168
Idioma original: Español
DOI:10.1016/j.arteri.2021.02.001
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