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El bloqueo interatrial avanzado predice recurrencia de infarto cerebral embólico de origen no determinado
Advanced interatrial block predicts recurrence of embolic stroke of undetermined source
K. Carrillo-Lozaa, A. Baranchukb, F. Serranoc, S. Hassebb, F. Espinosa Lirac, E. Sorianoc, A. Arauzc,
Autor para correspondencia
antonio.arauz@prodigy.net.mx

Autor para correspondencia.
a Servicio de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
b Division of Cardiology, Queen's University, Kingston, Ontario, Canadá
c Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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&#40;ESUS por sus siglas en ingl&#233;s&#41; fue recientemente introducido por un grupo internacional de trabajo sobre infarto cerebral criptog&#233;nico&#44; con la finalidad de identificar a pacientes con caracter&#237;sticas cl&#237;nicas y radiol&#243;gicas sugestivas de IC emb&#243;lico&#44; en los cuales la fuente de embolismo permanece no identificada&#44; a pesar de una investigaci&#243;n adecuada<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los pacientes con ESUS representan un grupo heterog&#233;neo con alta probabilidad de tener una fuente emb&#243;lica cardiaca oculta y con mayor riesgo de recurrencia de IC<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46; Estudios recientes apoyan una emergente conceptualizaci&#243;n del papel de la aur&#237;cula izquierda en el riesgo de IC y de su prevenci&#243;n&#44; sugiriendo una mayor relevancia de la disfunci&#243;n auricular en el riesgo de IC<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#8211;24</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo del estudio fue analizar si el BIA predice mayor recurrencia IC en pacientes con ESUS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Analizamos los datos de 104 pacientes con diagn&#243;stico confirmado de ESUS&#44; atendidos en Insituto Nacional de Neurologia y Neurocirugia de la Ciuad de M&#233;xico entre enero del 2000 y abril de 2018&#46; Usamos los datos prospectivamente incluidos en nuestro registro institucional de ictus&#44; siguiendo un protocolo estandarizado&#46; Nuestro registro de pacientes incluye los datos demogr&#225;ficos&#44; factores de riesgo vascular&#44; subtipo de evento vascular cerebral&#44; tratamiento&#44; hallazgos de laboratorio e imagen y evoluci&#243;n funcional al egreso y en la evoluci&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Utilizamos los criterios diagn&#243;sticos propuestos por el grupo internacional &#40;<span class="elsevierStyleItalic">Cryptogenic Stroke&#47;ESUS International working group</span>&#41;&#44; que define como ESUS a un IC no lacunar&#44; con ausencia de ateroesclerosis intra- o extracraneal &#40;estenosis &#62; 50&#37; en la arteria que irriga la zona de infarto&#41;&#44; sin fuentes embol&#237;genas cardiacas detectadas por ecocardiograma transtor&#225;cico y al menos monitorizaci&#243;n Holter de frecuencia cardiaca de 24 horas y sin otras causas definidas de IC<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46; En todos los casos se calcul&#243; la escala de CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los criterios del consenso de Electrocardiolog&#237;a 2012 para el diagn&#243;stico de BIA fueron utilizados&#59; donde BIA parcial &#40;BIA-p&#41; se define como prolongaci&#243;n de la onda P &#62; 120<span class="elsevierStyleHsp" style=""></span>ms y el BIA avanzado &#40;BIA-a&#41; como la prolongaci&#243;n de la onda P &#62; 120<span class="elsevierStyleHsp" style=""></span>ms&#44; m&#225;s la presencia de la morfolog&#237;a bif&#225;sica de la onda P con una fase negativa como fase terminal en derivaciones D-II&#44; D-III y aVF<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En todos los casos el ECG realizado durante el evento &#237;ndice fue evaluado e interpretado de forma centralizada y ciega en Queen&#769;s University&#44; Canad&#225;&#44; utilizando el programa semiautomatizado Cardio Calipers 3&#46;3&#46; Se registr&#243; la frecuencia cardiaca&#44; duraci&#243;n de onda P&#44; intervalo PR y voltaje de la onda P en derivaci&#243;n I&#46; De acuerdo con los hallazgos del ECG&#59; se subdividi&#243; a la poblaci&#243;n en 3 grupos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#59; sin BIA&#44; con BIA-p y BIA-a&#46; Se excluyeron pacientes con ECG con otro ritmo diferente al sinusal&#44; con m&#250;ltiples complejos auriculares o ventriculares y&#47;o con bloqueo auriculoventricular de segundo o tercer grado&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">El desenlace primario fue la recurrencia de IC en pacientes con ESUS&#44; definido como un nuevo IC&#44; con nuevo d&#233;ficit neurol&#243;gico o incremento de la sintomatolog&#237;a neurol&#243;gica previa&#44; de al menos 24 horas de duraci&#243;n y con confirmaci&#243;n por medio de estudios de imagen cerebral&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El periodo de seguimiento incluy&#243; evaluaciones neurol&#243;gicas en nuestra cl&#237;nica al ingreso&#44; alta hospitalaria&#44; 3 y 6 meses del egreso y final de seguimiento&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La evoluci&#243;n funcional se evalu&#243; con la escala modificada de Rankin &#40;emR&#41;&#59; se consider&#243; buen pron&#243;stico funcional a la emR entre 0 y 2&#59; y mal pron&#243;stico emR 3 a 5&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El comit&#233; de &#233;tica e investigaci&#243;n de nuestro hospital aprob&#243; la realizaci&#243;n del estudio y no se requiri&#243; de consentimiento informado por su naturaleza&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico fue realizado utilizando el programa IBM SPSS para Macintosh&#44; versi&#243;n 22&#46; Las variables categ&#243;ricas fueron expresadas en frecuencias y porcentajes&#46; Las variables continuas como medias y desviaci&#243;n est&#225;ndar &#40;DE&#41; o medianas con rango intercuartilar &#40;RIQ&#41;&#44; de acuerdo a la prueba de normalidad de Kolmogorov-Smirnov&#46; Las variables categ&#243;ricas fueron comparadas con prueba chi-cuadrado o exacta de Fisher&#46; Se compar&#243; la media de variables continuas con prueba t Student o U Mann Whitney y la varianza de estas con ANOVA o Kruskal Wallis seg&#250;n corresponda a su distribuci&#243;n&#46; Se realiz&#243; an&#225;lisis multivariado con modelo de regresi&#243;n log&#237;stica binaria y modelo de riesgos proporcionales de Cox&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nuestra base de datos del Insituto Nacional de Neurologia y Neurocirugia de la Ciuad de M&#233;xico incluye un total de 1&#46;673 pacientes con IC&#59; 104 &#40;6&#44;2&#37;&#41; cumplieron con los criterios de inclusi&#243;n de IC tipo ESUS&#46; La mediana de edad de la poblaci&#243;n estudiada &#40;n&#61;104&#41; fue de 47 a&#241;os &#40;rango 19-85&#41;&#59; 57 &#40;54&#37;&#41; pacientes eran menores de 50 a&#241;os y 52 &#40;50&#37;&#41; mujeres&#46; Los factores de riesgo m&#225;s frecuentemente encontrados fueron hipertensi&#243;n arterial en 46 casos &#40;44&#37;&#41;&#44; diabetes mellitus 19 &#40;18&#37;&#41;&#44; tabaquismo 34 &#40;33&#37;&#41;&#44; dislipidemia 35 &#40;34&#37;&#41; y uso de drogas 6 &#40;5&#44;8&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se document&#243; la presencia de BIA en 36 pacientes &#40;34&#44;6&#37;&#41;&#59; 29 con BIA-p &#40;27&#44;9&#37;&#41; y 7 con BIA-a &#40;6&#44;7&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes de acuerdo al hallazgo de BIA&#46; La presencia de BIA-p y BIA-a fue m&#225;s frecuente en mayores de 50 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Al final del seguimiento &#40;mediana 15 meses&#44; RIQ 10-48&#41; la evoluci&#243;n funcional fue buena &#40;mRs de 0 a 2&#41; en 82&#37; &#40;n&#61;85&#41; de los pacientes y mala &#40;mRs 3 a 5&#41; en 18&#37; &#40;n&#61; 19&#41;&#46; No se observ&#243; mortalidad en esta cohorte&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La recurrencia de IC ocurri&#243; en 16 pacientes &#40;15&#44;4&#37;&#41;&#44; 14 de ellos en territorio de arteria cerebral media y 2 en territorio vascular cerebral posterior&#59; 4 pacientes menores de 50 a&#241;os y 12 pacientes mayores de 50 a&#241;os &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;008&#41; OR 4&#44;76 &#40;IC 95&#37; 1&#44;42-15&#44;98&#41;&#44; RR 3&#44;78 &#40;IC 95&#37; 1&#44;31-10&#44;96&#41;&#59; de los cuales 7 no ten&#237;an BIA&#44; 5 pacientes con BIA-p &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;76&#41; y en 4 pacientes con BIA-a &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;010&#41; OR 9&#44;44 &#40;IC 95&#37; 1&#44;88-47&#44;46&#41;&#44; RR 4&#44;62 &#40;IC 95&#37; 2&#44;01-10&#44;61&#41;&#46; La densidad de incidencia para recurrencia de IC en esta serie fue de 0&#44;046&#59; es decir&#44; 4&#44;6 casos de recurrencia de IC por cada 100 a&#241;os persona de seguimiento en pacientes con ESUS&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La duraci&#243;n de la onda P fue mayor en pacientes con recurrencia&#44; mediana de 123<span class="elsevierStyleHsp" style=""></span>ms &#40;milisegundo&#41; vs&#46; 113<span class="elsevierStyleHsp" style=""></span>ms &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;009&#41;&#59; mientras que no se encontraron diferencias en el intervalo PR o voltaje de la onda P en derivaci&#243;n I &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariado con modelo de regresi&#243;n log&#237;stica binaria &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; los factores de riesgo independientes para recurrencia de IC fueron&#58; BIA-a <span class="elsevierStyleItalic">p</span>&#60;0&#44;001&#44; OR 10&#44;86 &#40;IC 95&#37; 3&#44;07-38&#44;46&#41;&#44; g&#233;nero masculino <span class="elsevierStyleItalic">p</span>&#61;0&#44;028&#44; OR 4&#44;60 &#40;IC 95&#37; 1&#44;18&#8211;17&#44;96&#41; y edad mayor a 50 a&#241;os <span class="elsevierStyleItalic">p</span>&#61;0&#44;039&#44; OR 3&#44;84 &#40;IC 95&#37; 1&#44;06-13&#44;88&#41;&#59; mientras que en modelo de riesgos proporcionales de Cox &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; lo fueron&#58; edad mayor a 50 a&#241;os <span class="elsevierStyleItalic">p</span>&#61;0&#44;002 HR 7&#44;04 &#40;IC 95&#37; 2&#44;06 &#8211; 23&#44;8&#41; y duraci&#243;n de la onda P &#40;por ms&#41; <span class="elsevierStyleItalic">p</span>&#61;0&#44;007 HR 1&#44;02 &#40;IC 95&#37; 1&#44;01 -1&#44;04&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">El paciente con IC de origen no determinado&#44; debe ser estudiado adecuadamente y descartarse enfermedades hematol&#243;gicas ante alto &#237;ndice de sospecha<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El BIA-a se asocia con un riesgo incrementado de IC<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;8&#44;12&#44;13</span></a>&#46; Esta asociaci&#243;n parece estar limitada a infartos no lacunares y se mantiene&#44; independientemente de la documentaci&#243;n de FA&#46; En nuestro estudio&#44; el BIA-a se asoci&#243; con mayor recurrencia de IC en pacientes con ESUS&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nuestros hallazgos refuerzan el argumento de que la enfermedad auricular &#40;atriopat&#237;a&#41; debe considerarse como un factor de riesgo independiente para ictus isqu&#233;mico y sugieren tambi&#233;n que el tromboembolismo auricular izquierdo puede ocurrir independiente de la documentaci&#243;n de FA&#46; Aunque nuestros pacientes pudieron haber presentado FA subcl&#237;nica&#44; el aspecto importante de nuestros hallazgos es que el riesgo de recurrencia existe con la documentaci&#243;n &#250;nica de BIA en el ECG de superficie&#59; el cual es un m&#233;todo sencillo&#44; accesible y altamente reproducible&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">O&#769;Neal et al&#46;&#44; examinaron la asociaci&#243;n entre BIA-a e incidencia de IC en el estudio <span class="elsevierStyleItalic">Atheroesclerosis Risk in Communities Study</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a>&#46; De manera similar a nuestros resultados&#44; encontraron que el BIA-a fue un factor de riesgo independiente para IC<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; nuestro estudio incluye una poblaci&#243;n altamente seleccionada de pacientes con IC&#44; en los que se descart&#243; FA &#40;de manera cl&#237;nica y con un registro Holter&#41; y enfermedad carot&#237;dea ateroescler&#243;tica&#44; pero sus caracter&#237;sticas cl&#237;nicas y de imagen&#44; sugieren fuertemente un mecanismo embol&#237;geno&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se estima que en los Estados Unidos&#44; ocurren aproximadamente 700&#46;000 nuevos casos de IC por a&#241;o&#44; de los cuales un tercio corresponde a este tipo de IC y hasta ahora no se ha determinado cu&#225;l es el mejor tratamiento de prevenci&#243;n secundaria<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">26&#44;27</span></a>&#46; Algunos estudios en curso eval&#250;an si el tratamiento con anticoagulantes orales directos &#40;ACD&#41;&#44; reduce el riesgo de recurrencia<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">28&#8211;30</span></a>&#46; A la fecha&#44; se han dado a conocer los resultados de dos estudios en pacientes con IC ESUS tratados con ACD&#59; el estudio ESUS NAVIGATE&#44; que compar&#243; 15<span class="elsevierStyleHsp" style=""></span>mg de rivaroxaban contra 100<span class="elsevierStyleHsp" style=""></span>mg de aspirina&#59; y el estudio RESPECT ESUS&#44; que compar&#243; dos dosis de dabigatr&#225;n &#40;100 y 150 mgs dos veces por d&#237;a&#41; contra aspirina&#46; Ambos ensayos cl&#237;nicos fallaron en demostrar la eficacia de los ACD en la prevenci&#243;n de recurrencia de IC en este grupo de pacientes y en el caso de rivaroxaban&#44; se asoci&#243; con mayor riesgo de hemorragia<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">28&#44;31</span></a>&#46; Sin embargo&#44; un aspecto de importancia es que en el estudio ESUS NAVIGATE&#44; ambos grupos de tratamiento mostraron una tasa elevada de recurrencia&#44; lo que confirma la necesidad de una mejor selecci&#243;n de pacientes y mejor opci&#243;n terap&#233;utica&#46; Queda por demostrar si una selecci&#243;n de pacientes usando el mismo m&#233;todo de nuestro trabajo y randomizaci&#243;n de estos incluyendo solo el grupo con BIA-a hubiera podido segregar una poblaci&#243;n de mayor riesgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El estudio <span class="elsevierStyleItalic">AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke</span>&#44; se encuentra actualmente en curso e incluye pacientes con ESUS y cardiopat&#237;a auricular aleatorizados a recibir apixaban o aspirina<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a>&#46; Sus resultados podr&#237;an aclarar si el alto riesgo de recurrencia de IC en pacientes con ESUS&#44; y marcadores de disfunci&#243;n auricular&#44; puede ser reducido con otras alternativas de anticoagulaci&#243;n&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Nuestros hallazgos sugieren que la detecci&#243;n de BIA-a&#44; en pacientes con ESUS&#59; permite identificar a pacientes de alto riesgo de recurrencia&#44; en los que algunas terapias farmacol&#243;gicas podr&#237;an ser beneficiosas&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitaciones</span><p id="par0140" class="elsevierStylePara elsevierViewall">Algunas limitaciones de nuestro estudio debieran ser resaltadas&#46; Se trata de un an&#225;lisis retrospectivo de una serie de pacientes incluidos prospectivamente y podr&#237;a existir sesgo inherente a este tipo de dise&#241;o&#46; Para fortalecer los hallazgos vale aclarar que el an&#225;lisis de los ECG se realiz&#243; de manera ciega respecto a los eventos finales&#46; En segundo lugar&#44; se trata de un estudio de un solo centro neurol&#243;gico&#46; Finalmente&#44; el n&#250;mero acotado de pacientes&#44; con promedio de edad menor a la reportada en otras series&#44; no permite extrapolar estos hallazgos de manera conclusiva&#44; y un estudio prospectivo con mayor n&#250;mero de pacientes ser&#237;a altamente deseable&#59; as&#237; como uno donde se comparare la recurrencia de IC en pacientes con BIAa con y sin hipertensi&#243;n arterial&#44; puesto que su pron&#243;stico puede diferir<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a>&#46; Existen otras interrogantes que tendr&#225;n que ser respondidas en futuros ensayos cl&#237;nicos&#59; como si el uso de antiarr&#237;tmicos y&#47;o anticoagulantes deber&#237;an usarse en este subgrupo de pacientes&#44; para prevenir fibrilaci&#243;n auricular y recurrencia de infarto cerebral&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">El bloqueo interatrial avanzado y la edad mayor de 50 a&#241;os predicen recurrencia de infarto cerebral emb&#243;lico de causa no determinada &#40;ESUS&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El bloqueo interatrial avanzado &#40;BIA-a&#41; es considerado un factor de riesgo independiente para infarto cerebral &#40;IC&#41;&#46; Nuestro objetivo fue analizar si el BIA-a predice recurrencia de IC en pacientes con infarto cerebral emb&#243;lico de origen no determinado &#40;ESUS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ciento cuatro pacientes con diagn&#243;stico confirmado de ESUS fueron seguidos durante una mediana de 15 meses &#40;RIQ 10-48&#41;&#46; Los datos cl&#237;nicos&#44; las caracter&#237;sticas de la onda P y presencia de BIA en electrocardiograma realizado durante el evento &#237;ndice&#44; fueron registrados&#46; La interpretaci&#243;n de los electrocardiogramas se realiz&#243; de forma centralizada y ciega en &#40;XXXX2&#41;&#46; La recurrencia de ESUS fue el desenlace primario&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad de los casos fue de 47 a&#241;os &#40;rango 19-85&#41;&#59; 50&#37; fueron mujeres&#46; Se encontr&#243; BIA en 36 casos &#40;34&#44;6&#37;&#41;&#59; parcial &#40;BIA-p&#41; en 29 &#40;27&#44;9&#37;&#41; y BIA-a en 7&#40;6&#44;7&#37;&#41;&#46; Diecis&#233;is pacientes &#40;15&#44;4&#37;&#41; presentaron IC recurrente&#59; de los cuales 5 ten&#237;an BIA-p y 4 BIA-a &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;01&#59;OR 9&#44;44&#58;IC 95&#37; 1&#44;88-47&#44;46&#41;&#46; La mediana de duraci&#243;n de la onda P fue mayor en pacientes con recurrencia &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;009&#41;&#46; En el an&#225;lisis multivariado de regresi&#243;n log&#237;stica&#44; los factores de riesgo independientes para recurrencia de IC fueron&#58; el BIA-a &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#44;001&#59; OR 10&#44;86&#58;IC 95&#37; 3&#44;07-38&#44;46&#41;&#44; g&#233;nero masculino &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;028&#59; OR 4&#44;6&#58;IC 95&#37; 1&#44;18-17&#44;96&#41; y la edad mayor a 50 a&#241;os &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;039&#59; OR 3&#44;84&#58;IC 95&#37; 1&#44;06-13&#44;88&#41;&#59; en riesgos proporcionales de Cox fueron&#58; edad mayor a 50 a&#241;os &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#44;002&#59; HR 7&#44;04&#58;IC 95&#37; 2&#44;06&#8211;23&#44;8&#41; y duraci&#243;n de la onda P &#40;por ms&#41; <span class="elsevierStyleItalic">p</span>&#61;0&#44;007 &#40;HR 1&#44;02&#58;IC 95&#37; 1&#44;01-1&#44;04&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El BIA-a y edad mayor a 50 a&#241;os predicen recurrencia de ESUS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Advanced interatrial block &#40;IAB&#41; is an independent risk factor for ischaemic stroke&#46; This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source &#40;ESUS&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months &#40;interquartile range&#44; 10-48&#41;&#46; We recorded data on clinical variables&#44; P-wave characteristics&#44; and presence of IAB on the electrocardiogram&#46; Electrocardiogram findings were interpreted by a blinded&#44; centralised rater at &#40;XXXX2&#41;&#46; ESUS recurrence was the primary outcome variable&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Median age was 47 years &#40;range&#44; 19-85&#41;&#59; 50&#37; of patients were women&#46; IAB was detected in 36 patients &#40;34&#46;6&#37;&#41;&#59; IAB was partial in 29 cases &#40;27&#46;9&#37;&#41; and advanced in 7 &#40;6&#46;7&#37;&#41;&#46; Sixteen patients &#40;15&#46;4&#37;&#41; presented stroke recurrence&#59; of these&#44; 5 had partial and 4 had advanced IAB &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;01&#59; odds ratio &#91;OR&#93;&#160;&#61; 9&#46;44&#59; 95&#37; confidence interval &#91;CI&#93;&#44; 1&#46;88-47&#46;46&#59; relative risk &#91;RR&#93; &#61;&#160;4&#46;62&#59; 95&#37;&#160;CI&#44; 2&#46;01-10&#46;61&#41;&#46; Median P-wave duration was longer in patients with stroke recurrence &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;009&#41;&#46; The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence&#58; advanced IAB &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#59; OR&#160;&#61;&#160;10&#46;86&#59; 95&#37; CI&#44; 3&#46;07-38&#46;46&#41;&#44; male sex &#40;<span class="elsevierStyleItalic">P</span> &#61;&#160;&#46;028&#59; OR&#160;&#61;&#160;4&#46;6&#59; 95&#37; CI&#44; 1&#46;18-17&#46;96&#41;&#44; and age older than 50 years &#40;<span class="elsevierStyleItalic">P</span> &#61;&#160;&#46;039&#59; OR&#160;&#61;&#160;3&#46;84&#59; 95&#37;&#160;CI&#44; 1&#46;06-13&#46;88&#41;&#46; In the Cox proportional hazards model&#44; the risk variables identified were age older than 50 years &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;002&#59; hazard ratio&#44; 7&#46;04&#59; 95&#37;&#160;CI&#44; 2&#46;06-23&#46;8&#41; and P-wave duration &#40;per ms&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;007&#59; hazard ratio&#44; 1&#46;02&#59; 95&#37;&#160;CI&#44; 1&#46;01-1&#46;04&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Advanced IAB and age older than 50 years predict ESUS recurrence&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ejemplos de BIA en comparaci&#243;n con un electrocardiograma con onda P normal&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BIA&#58; bloqueo interatrial&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Prueba X<span class="elsevierStyleSup">2</span> exacta de Fisher&#44; valor <span class="elsevierStyleItalic">p</span> de hemogeneidad&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BIA&#58; bloqueo interatrial&#59; ESUS&#58; infarto cerebral emb&#243;lico de origen no determinado &#40;por sus siglas en ingl&#233;s&#59; embolic stroke of undetermined source&#41;&#59; RIQ&#58; rango intercuartilar&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin BIA&#44; n&#61;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exacta de FisherValor <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Edad&#44; mediana &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#40;49-73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;03<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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
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                  \t\t\t\t">G&#233;nero masculino&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#40;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#40;65&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;16&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  " align="char" valign="\n
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                  \t\t\t\t">27&#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">15&#40;52&#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="char" valign="\n
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                  \t\t\t\t">4&#40;57&#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
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                  \t\t\t\t">0&#44;44&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
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                  \t\t\t\t">Diabetes mellitus II&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#40;27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#40;28&#44;6&#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
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                  \t\t\t\t">0&#44;14&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
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                  \t\t\t\t">Tabaquismo&#44; n &#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="char" valign="\n
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                  \t\t\t\t">20&#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;96&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
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                  \t\t\t\t">Dislipidemia&#44; n &#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="char" valign="\n
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                  \t\t\t\t">27&#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#40;24&#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
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                  \t\t\t\t">1&#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
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                  \t\t\t\t">0&#44;71&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">Cardiopat&#237;a isqu&#233;mica&#44; n &#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;1&#44;5&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;14&#44;3&#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">0&#44;21&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">Toxicoman&#237;a previa&#44; n &#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="char" valign="\n
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                  \t\t\t\t">6&#40;8&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#40;0&#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">0&#44;25&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">CHA2 DS2 VASc &#8805;3&#44; n &#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#40;76&#44;5&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#40;79&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#40;86&#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;0&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">Recurrencia de IC&#44; n &#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#40;10&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#40;17&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#40;57&#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">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Prueba Kruskal Wallis&#46;</p>"
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        ]
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caractacter&#237;sticas demogr&#225;ficas y cl&#237;nicas de pacientes con ESUS</p>"
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      ]
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        "identificador" => "tbl0010"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Kolmogorov-Smirnov con distribuci&#243;n no param&#233;trica&#44; prueba U Mann Whitney &#40;significaci&#243;n bilateral&#41;&#44; prueba Kruskal Wallis con igualdad de varianza&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n estandar&#59; IC&#58; infarto cerebral&#59; ms&#58; milisegundo&#59; mV&#58; milivoltio&#59; RIQ&#58; rango intercuartilar&#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
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\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">Recurrencia&#44; n&#61;16&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">Sin recurrencia&#44; n&#61;88&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor <span class="elsevierStyleItalic">p</span>&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
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                  \t\t\t\t">Edad en a&#241;os&#44; n &#40;mediana&#41;RIQ&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">16 &#40;62&#41; 49-72&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">88 &#40;44&#44;5&#41; 31-63&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;023&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">Frecuencia cardiaca&#44; n &#40;media&#41;DE&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">16 &#40;70&#44;6&#41; &#177;14&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">88 &#40;72&#44;6&#41; &#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">0&#44;63<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">Duraci&#243;n &#40;ms&#41; de onda P&#44; n &#40;mediana&#41;RIQ&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">16 &#40;123&#41; 114-134&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">88 &#40;113&#41; 102&#44;6-120&#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">0&#44;009&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">Intervalo PR duraci&#243;n &#40;ms&#41;&#44; n &#40;mediana&#41;RIQ&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">16 &#40;162&#44;5&#41; 150-179&#44;5&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">88 &#40;157&#41; 144-171&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;14&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">Voltaje &#40;mV&#41; Onda P en D-I&#44;n &#40;mediana&#41;RIQ&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 &#40;0&#44;10&#41; 0&#44;08-0&#44;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">86 &#40;0&#44;09&#41; 0&#44;07-0&#44;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">0&#44;35&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">CHA2 DS2 VASc &#8805; 3&#44; n&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">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&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;75<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Prueba Kolmogorov-Smirnov con distribuci&#243;n param&#233;trica&#44; prueba t Student &#40;significaci&#243;n bilateral&#41;&#44; prueba ANOVA con igualdad en varianza&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Prueba exacta de Fisher&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas electrocardiogr&#225;ficas de los pacientes con y sin recurrencia de IC</p>"
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        "identificador" => "tbl0015"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">BIA&#58; bloqueo interatrial&#59; ESUS&#58; infarto cerebral emb&#243;lico de causa no determinada &#40;por sus siglas en ingl&#233;s&#44; embolic stroke of undetermined source&#41;&#59; IC&#58; intervalo de confianza&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\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">Factor de riesgo<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor p&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 &#40;IC 95&#37;&#41;&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">BIA avanzado&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;0&#44;001&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">10&#44;86 &#40;3&#44;07 - 38&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">G&#233;nero masculino&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;028&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&#44;60 &#40;1&#44;18 &#8211; 17&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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 mayor a 50 a&#241;os&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;039&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02134853
Idioma original: Español
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