Pulmonary hypertension: Real-world data from a Portuguese expert referral centre

array:24 ["pii" => "S2531043718300370" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2018.02.003" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "15" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Pulmonol. 2018;24:231-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1758 "formatos" => array:3 [ "EPUB" => 147 "HTML" => 1258 "PDF" => 353 ] ] "itemSiguiente" => array:19 [ "pii" => "S217351151730180X" "issn" => "25310437" "doi" => "10.1016/j.rppnen.2017.10.010" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1305" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Pulmonol. 2018;24:241-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3283 "formatos" => array:3 [ "EPUB" => 159 "HTML" => 2443 "PDF" => 681 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Association between oxygenation and ventilation indices with the time on invasive mechanical ventilation in infants" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "241" "paginaFinal" => "249" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2188 "Ancho" => 1500 "Tamanyo" => 120379 ] ] "descripcion" => array:1 [ "en" => "(A) Oxygenation index in the first seven days of invasive mechanical ventilation (IMV). The p-value [mean to ≤7days ± standard deviation; median (green line) and mean to > 7 days±standard deviation; median (red line)] was shown in sequence to oxygenation index. Day 1 (141 patients): p-value=0.331 (8.92±9.05; 5.63 and 8.7±6.68; 7.07). Day 2 (141 patients): p-value < 0.001 (6.28±6.01; 4.15 and 9.1±6.38; 7.05). Day 3 (134 patients): p-value=0.001 (4.96±4.09; 3.45 and 7.95±5.67; 6.08). Day 4 (114 patients): p-value=0.001 (4.85±3.37; 3.47 and 7.24±4.96; 5.89). Day 5 (102 patients): p-value=0.011 (6.25±6.08; 3.62 and 7.87±5.22; 6.33). Day 6 (96 patients): p-value=0.01 (4.68±2.6; 3.62 and 7.77±6.15; 6). Day 7 (83 patients): p-value=0.117 (3.98±1.83; 4.19 and 7.25±5.76; 5.38). Differences were found in oxygenation index from the second to the sixth day, the values were higher in the long-term IMV. Also, we compared the evolution of oxygenation index among IMV days according to ≤ short time (p-value=0.033) and long time (p-value < 0.001). (B) Ventilatory index in the first seven days of IMV. The p-value [mean to ≤7days±standard deviation; median (green line) and mean to >7 days±standard deviation; median (red line)] was shown in sequence to the oxygenation index. Day 1 (140 patients): p-value=0.009 (26.21±18.13; 22.4 and 32.64±18.76; 26.88). Day 2 (141 patients): p-value < 0.001 (22.6±17.33; 16.33 and 32.99±15.59; 27.26). Day 3 (134 patients): p-value < 0.001 (17.84±14.74; 16.39 and 33.65±20.75; 29.06). Day 4 (114 patients): p-value < 0.001 (14.78±7.56; 12.05 and 30.23±15.44; 27.61). Day 5 (102 patients): p-value < 0.001 (15.03±7.71; 12.44 and 29.14±16.63; 25.5). Day 6 (96 patients): p-value<0.001 (12.44±6.97; 11.53 and 28.3±16.63; 25.63). Day 7 (83 patients): p-value=0.009 (12.35±4.87; 11.04 and 25.12±14.39; 22). Differences were found in ventilation index from the first to the seventh day, the values were higher in the long-term IMV. Also, we compared the evolution of ventilation index among IMV days according to ≤ short time (p-value<0.001) and long time (p-value<0.001). We adopted the alpha=0.05 for all statistical tests performed. Data were analyzed by the Mann–Whitney U test and Friedman's test Two-Way Analysis of Variance test." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.A. Camargo Barros Rocha, F.A.L. Marson, C.C.B. Almeida, A.A. Almeida Junior, J.D. Ribeiro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D.A." "apellidos" => "Camargo Barros Rocha" ] 1 => array:2 [ "nombre" => "F.A.L." "apellidos" => "Marson" ] 2 => array:2 [ "nombre" => "C.C.B." "apellidos" => "Almeida" ] 3 => array:2 [ "nombre" => "A.A." "apellidos" => "Almeida Junior" ] 4 => array:2 [ "nombre" => "J.D." "apellidos" => "Ribeiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151730180X?idApp=UINPBA00004E" "url" => "/25310437/0000002400000004/v2_201810040624/S217351151730180X/v2_201810040624/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2531043718300205" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2017.12.006" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "7" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Pulmonol. 2018;24:224-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2084 "formatos" => array:3 [ "EPUB" => 156 "HTML" => 1470 "PDF" => 458 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Role of the impulse oscillometry in the evaluation of tracheal stenosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "230" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Linhas, F. Lima, D. Coutinho, J. Almeida, S. Neves, A. Oliveira, I. Ladeira, R. Lima, S. Campainha, M. Guimarães" "autores" => array:10 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Linhas" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Lima" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Coutinho" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Almeida" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Neves" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Oliveira" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Ladeira" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Lima" ] 8 => array:2 [ "nombre" => "S." "apellidos" => "Campainha" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Guimarães" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043718300205?idApp=UINPBA00004E" "url" => "/25310437/0000002400000004/v2_201810040624/S2531043718300205/v2_201810040624/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Pulmonary hypertension: Real-world data from a Portuguese expert referral centre" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "231" "paginaFinal" => "240" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Gomes, C. Cruz, J. Rocha, M. Ricardo, M. Vicente, A. Melo, M. Santos, L. Carvalho, F. Gonçalves, A. Reis" "autores" => array:10 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Ricardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Melo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Santos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "L." "apellidos" => "Carvalho" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "F." "apellidos" => "Gonçalves" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 9 => array:4 [ "nombre" => "A." "apellidos" => "Reis" "email" => array:1 [ 0 => "reisabilio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto – Hospital de Santo António, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Health Sciences, University of Aveiro, Aveiro, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto Hospital de Santo António, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Cardiology Service, Medicine Department, Centro Hospitalar do Porto – Hospital de Santo António, Porto, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Pulmonary Vascular Disease Unit, Centro Hospitalar do Porto – Hospital de Santo, António, 4099-001 Porto, Portugal." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1264 "Ancho" => 1424 "Tamanyo" => 89719 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier survival curve for the overall study cohort, patients with PAH (Group 1 PH) and patients with CTEPH (Group 4 PH)." ] ] ] "textoCompleto" => "IntroductionPulmonary hypertension (PH) is an heterogeneous condition associated with various underlying disorders, which is defined as at rest mean pulmonary arterial pressure (mPAP) ≥25mmHg confirmed by right heart catheterisation (RHC).<a class="elsevierStyleCrossRef" href="#bib0230">1</a> The pathophysiological processes associated with the development of PH are complex and more than likely multifactorial, why explains why several types of classification have been proposed over the years. The most recent international consensus from the 5th World Symposium held in Nice in 2013, classifies PH according to five general groups of aetiologies.<a class="elsevierStyleCrossRef" href="#bib0235">2</a> Group 1 PH refers to pulmonary arterial hypertension (PAH) and includes idiopathic pulmonary arterial hypertension (IPAH), heritable pulmonary arterial hypertension (HPAH), and drugs and toxin induced; PH associated with diseases such as connective tissue disease (CTD), HIV infection, portal hypertension, congenital heart disease (CHD) and schistosomiasis are also included in Group 1. Group 1′ and Group 1″ refer to pulmonary veno-occlusive disease and/or pulmonary capillary haemangiomatosis and persistent pulmonary hypertension of the newborn, respectively. Group 2 PH includes PH due to left heart disease (LHD). Group 3 refers to PH due to lung diseases or hypoxia, such as chronic obstructive pulmonary disease (COPD) or interstitial lung disease. Group 4 PH includes chronic thromboembolic pulmonary hypertension (CTEPH) and other pulmonary artery obstructions. Group 5 refers to PH with unclear and/or multifactorial mechanisms.Group 1 (PAH) aetiologies, except schistosomiasis associated PAH, are considered rare diseases; IPAH being an exclusion diagnosis, is the most studied form of PAH and the model for clinical management of PAH forms which are indicated for targeted therapy.<a class="elsevierStyleCrossRefs" href="#bib0240">3,4</a> Treatment of PH involves both conventional, symptom-based therapy and targeted therapy, which is indicated for specific PH aetiologies. Conventional treatment involves the use of digoxin to improve right ventricular function, diuretics to reduce peripheral oedema, supplemental oxygen, and in specific cases anticoagulants.<a class="elsevierStyleCrossRef" href="#bib0240">3</a> Calcium channel blockers (CCBs) can be used to lower PAP, but their use is restricted to a small percentage of patients (3–5%) showing positive response to acute pulmonary vasodilator (ARVT) challenge.<a class="elsevierStyleCrossRefs" href="#bib0250">5,6</a> Targeted therapy includes the use of endothelin-1 receptor antagonists (ERA),<a class="elsevierStyleCrossRefs" href="#bib0260">7–9</a> phosphodiesterase-5 inhibitors (PDE-5I),<a class="elsevierStyleCrossRefs" href="#bib0275">10,11</a> soluble guanylate cyclase (sGC) stimulators,<a class="elsevierStyleCrossRefs" href="#bib0285">12,13</a> and prostacyclin analogues or receptor agonists,<a class="elsevierStyleCrossRefs" href="#bib0295">14–19</a> surgical treatment, like lung or heart-lung transplantation is reserved to refractory cases of PAH; pulmonary angioplasty and pulmonary endarterectomy is reserved to CTEPH patients.The proliferation of studies assessing long-term prognosis of PH has helped identify considerably different patients and disease characteristics both over time and for populations in different geographical regions.<a class="elsevierStyleCrossRef" href="#bib0325">20</a> These findings suggest the need for specific regional data, to fully characterise local disease populations, inform clinical practice, and to help define local/regional political strategies.In Portugal, a national PH registry has been, but given its recent implementation, only short-term data have been published.<a class="elsevierStyleCrossRef" href="#bib0330">21</a> Recently, another study characterised the survival over a longer follow-up period but the sample size remained relatively small (n=66).<a class="elsevierStyleCrossRef" href="#bib0335">22</a>This study aims to provide long-term data for the Portuguese PH population, by characterising the clinical presentation, evolution, and outcomes of PH patients in a specialised referral centre in Portugal.Materials and methodsStudy populationWe conducted a retrospective analysis of a cohort of PH patients referenced to an expert tertiary care referral centre in northern Portugal (Pulmonary Vascular Disease Unit, Centro Hospitalar do Porto – Hospital de Santo António, Porto, Portugal) from 2002 to 2013. At this centre, patients followed a defined protocol for the clinical management of PH, which was adjusted to the applicable national<a class="elsevierStyleCrossRef" href="#bib0340">23</a> and international guidelines during the period of the study. The protocol specified mandatory clinical assessments, which were prospectively collected in dedicated PH software developed by the centre (PAHTool®, Inovultus Lda, Santa Maria da Feira, Portugal).PH was confirmed by right heart catheterisation (RHC), with a mean pulmonary artery pressure (mPAP) ≥25mmHg; pulmonary arterial wedge pressure (PAWP) ≤15mmHg was used to define pre-capillary PH. For the purposes of this study, clinical classification of PH followed standard criteria according to the consensus from the 5th World Symposium in Nice, 2013. Patients with left heart disease (LHD) (Group 2 PH) were not included in this study, due to the significantly different pathophysiology, treatment approaches, and prognosis.The study was approved by the ethics committee of Hospital de Santo António, Porto, Portugal. All patients provided their written informed consent prior to enrolment in the study.Medical carePatients received standard medical care throughout the period of the study. Treatment was prescribed by the accompanying physician based on national and international guidelines applicable at time of the study (as defined in the protocol implemented at the centre) and local treatment availability. Overall, all patients received standard conventional treatment when clinically indicated, including anticoagulants, diuretics, digoxin, oxygen supplementation, and high dose calcium channel blockers (CCBs) (if they were AVRT responders). Selected patients received molecular targeted therapy in addition to conventional therapy, including endothelin-1 receptor antagonists (ERA), phosphodiesterase-5 inhibitors (PDE-5I), and prostacyclin analogues.AssessmentsDemographic characteristics (gender and age) and clinical characteristics (PH aetiology, symptoms, WHO functional class, 6-min walking test (6MWT), N-terminal pro brain natriuretic peptide (NT-proBNP), and haemodynamic parameters) were collected at baseline. According to the protocol implemented at the centre, patients attended, routinely, 3–4 visits per year or if they had any sign of deterioration. During follow-up the following assessments were considered mandatory: type of treatment administered, clinical evaluation focused on signs of deterioration (like heart failure or syncope), WHO functional class, 6MWT, and NT-proBNP; and yearly haemodynamic re-evaluation. Survival was established based on the electronic medical records (EMR).Statistical methodsDemographic and clinical variables were summarised with descriptive statistics. Categorical variables were summarised as absolute frequency and percentage, whereas continuous variables were summarised as mean and standard deviation (SD). Student's t, Wilcoxon's, Fisher's exact, or chi-square tests were used to conduct paired/independent univariate/bivariate analysis as appropriate. Cumulative survival was estimated using the Kaplan–Meier method. Patients were censored at the end of the study, except for those who underwent lung transplantation, censored at the time of transplantation. Differences between the survival curves (according to baseline characteristics and disease aetiology) were analysed using the log-rank test. A 5% significance level was employed for all analyses. For the purpose of subgroup analysis patients with multiple aetiology were excluded from any subgroup analysis, except those for whom CTEPH was considered their main diagnosis.Data was retrieved from PAHTool®. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA).ResultsStudy population and baseline characteristicsDuring the enrolment period of the study, a total of 211 patients with suspected PH were referenced to the Pulmonary Vascular Disease Unit (PDVU). RHC confirmed PH in 120 patients, of which, 19 were excluded from the analysis (10 patients lost to follow-up and 9 patients with exclusive left heart disease), leading to a final study cohort of 101 patients with pcPH. The majority of patients represented incident cases (n=81, 80.2%), however, 20 (19.8%) patients had a prior diagnosis of congenital heart diseases before referral, having started specific therapy at admission to the centre. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> presents the patient disposition in the study cohort.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The mean±SD follow-up time in the overall study population was 3.8±2.7 years. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the baseline demographic and clinical characteristics of the study population. Approximately 66.3% of patients were female (3:1 ratio) and the mean±SD age at baseline was 49.6±19.6 years. Most participants showed moderate to severe disease manifestations at baseline, with 60.4% of patients presenting in WHO functional classes (FC) III or IV, with a mean NT-proBNP level of 1533.4±1758.3pg/mL, and walking a mean distance of 319.6±132.9m on 6MWT. Haemodynamically, patients showed increased mPAP of 48.5±16.5mmHg, increased PVR of 8.1±4.8 wood units, increased RAP 11.1±5.3mmHg, and normal CI of 3.0±1.1L/min.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The most frequent causes of PH were Group 1 PH – PAH (54.4%) and Group 4 PH – CTEPH (25.7%); from the PAH subgroup, CHD (36.3%) was the most frequent, followed by I/HPAH (32.7%), and CTD (20.0%); importantly, 17.8% of patients presented PH of multiple aetiology.Concerning the most frequent PH subgroups, I/HPAH and CHD patients were younger (P<0.001); for all subgroups of aetiologies most patients presented with WHO FC III/IV, but patients with CHD and CTEPH showed significantly (P<0.001) worst functional capacity at baseline.Treatment and clinical evolution<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows PH treatment used at the last follow-up visit. All patients received conventional treatment during the period of the study, with 8.9% of those receiving conventional therapy only. Targeted therapy was used with 91.1% of participants in addition to conventional therapy. 4 (6.8%) I/HPAH patients were AVRT responders, but only 2 were long-term responders, being treated with high doses of CCBs only.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Single targeted therapy was used in 42.6% of patients, dual combination therapy in 29.7%, and triple combination therapy in 18.8%. 42.3% of CTEPH patients underwent pulmonary endarterectomy during the course of the study. The majority of patients with I/HPAH were under combination therapy (88.9%), with 61.1% under triple therapy. Most patients with CTD (54.4%) and CHD (55.0%) were under combination therapy, and dual therapy was the most frequent type of treatment (36.4% and 45.0%, respectively). Patients with non-operable CTEPH or with residual persistent PH were mostly under monotherapy (57.7%), particularly with ERAs (46.2%).During patient follow-up, functional capacity improved significantly (P<0.003) from first to last visit for the overall study population, as illustrated in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. Mean 6MWD significantly improved in the overall population (P=0.003) and in the subgroup of I/HPAH patients (P=0.011). CHD subgroup was the only one to show a significant (P=0.040) improvement in NT-proBNP levels (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>There was a significant reduction in mPAP in the overall population (P=0.002) and in the subgroup of I/HPAH patients (P=0.008). PVR significantly improved in the overall population (P=0.008) and in the subgroup of I/HPAH patients (P=0.008). No significant changes were observed in RAP and CI for either the overall population or subgroup analyses.SurvivalDuring the follow-up period, a total of 28 (27.7%) patients died of PH-related causes; 10.7% of deaths occurred in patients with I/HPAH, 25.0% with CTEPH, 10.7% with CTD, and 25.0% with CHD. Patients with WHO FC III or IV at baseline represented 67.9% of deaths. Median survival time from diagnosis by RHC for the 28 deaths was 3.1 years. At the time of death 35.7% of patients were under monotherapy, 39.3% under dual therapy, 17.9% under triple therapy, and only 2 patients (7.1%) were under exclusive conventional therapy.<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents survival estimates for the overall study cohort and specific PH aetiologies. For the overall study cohort, 1-, 3-, and 5-year survival was estimated at 86.6%, 76.7%, and 64.1%, respectively. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the Kaplan–Meier survival curve for the overall cohort and for patients with PAH vs. CTEPH. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows specific Kaplan–Meier survival curves for subgroups of PAH (A) and according to CTEPH treatment (B).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Survival was significantly better for those ≤40 years old (10.5 vs. 6.4 years; P=0.003) and in women with I/HPAH compared with men (9.3 vs. 4.5 years; P=0.039); no other significant differences in survival were observed for gender, age, PH aetiology, and functional capacity analyses for the overall population and subgroups of aetiologies.DiscussionThis study provides long-term data for patient phenotypes, clinical evolution, and survival in PAH and CTEPH of a Portuguese PH population. These results build on previous findings<a class="elsevierStyleCrossRefs" href="#bib0330">21,24</a> and together they characterise the impact of this life-threatening disease in Portugal. The present study enrolled only patients with pcPH due to the substantially different disease characteristics and treatment approaches that could bias the results and ultimately hinder comparisons with other cohorts published over the years. Unlike previous studies, here we included patients with all types of PH, except for left heart disease, to provide a more accurate picture of pcPH as a whole. Left heart disease was the only PH group excluded from the analysis.The PH dedicated software developed by the centre allowed the implementation of a mandatory case report form (CRF) with automatic alerts to avoid missing data in our clinical records. This methodology allowed us to build a true real-world cohort of PH patients from our region and following the most recent Nice recommendations.<a class="elsevierStyleCrossRef" href="#bib0350">25</a> This is particularly relevant because PAHTool® is currently licenced for implementation in several PH centres worldwide, and its widespread use is envisioned to allow the generation of relevant real-world data, which is badly needed in the context of this non-frequent condition but rapidly evolving field.According to existing registries, some aetiologies are underrepresented in our cohort (particularly drugs and toxins induced PH, HIV and portal hypertension associated PH), which is most likely due to low physician awareness about PH.<a class="elsevierStyleCrossRefs" href="#bib0330">21,26–36</a> CHD (36.3% of PAH group) contributed with a comparatively higher proportion of cases, which can be explained by the past low levels of detection and correction of heart defects in infancy in our country and by the fact that our centre was for a long time the only one to provide targeted therapy for PAH in the region. CTEPH was the most frequent aetiology after PAH, confirming the high prevalence of this frequently forgotten condition and in line with studies that included this subgroup of patients.<a class="elsevierStyleCrossRefs" href="#bib0330">21,34,37–39</a>Comparing our data with the most important registries in the field, we found that CTEPH age at diagnosis in our population is consistent with these registries<a class="elsevierStyleCrossRefs" href="#bib0415">38–40</a>; although the mean age at diagnosis for our overall population is similar to the majority of PAH registries<a class="elsevierStyleCrossRefs" href="#bib0355">26,29,32</a> the mean age for I/HPAH is clearly lower and near the pioneer registries<a class="elsevierStyleCrossRefs" href="#bib0400">35,41</a> and those coming from the developing world,<a class="elsevierStyleCrossRefs" href="#bib0435">42,43</a> but still in line with national data.<a class="elsevierStyleCrossRef" href="#bib0330">21</a> Female gender (66%) predominance is also in line with the majority of PH registries and cohorts.<a class="elsevierStyleCrossRefs" href="#bib0330">21,26–35</a>Baseline clinical characteristics at presentation indicate some delay in diagnosis, with most patients presenting with intermediate or high risk of mortality indicated by high NYHA FC, low 6MWD and high NT-proBNP according to risk assessment guidelines<a class="elsevierStyleCrossRef" href="#bib0240">3</a>; increased RAP (11.1±5.3mmHg) and PVR (8.1±4.8WU) are also consistent with these findings. The proportion of patients presenting with intermediate or high risk explains why the great majority of patients were treated with combination therapy: I/HPAH (88.9%), CTD (54.5%) and CHD (55.0%). These findings are, however, above what has been reported in recent European studies, as well as national data.<a class="elsevierStyleCrossRefs" href="#bib0330">21,30,32,34,44</a> There is a particularly high proportion of I/HPAH (61.1%) patients under triple therapy, which is probably the result of the close follow-up adopted and continuous risk evaluation with early step up of the therapy. ERAs and PDE-5I were the most widely used drugs, which is in accordance with previous reports.<a class="elsevierStyleCrossRefs" href="#bib0330">21,30,32,34,44</a> Still, they were used far more frequently in combination than what has been reported, which is in line with the most recent recommendations for the early use of sequential or upfront double combination therapy.<a class="elsevierStyleCrossRefs" href="#bib0240">3,45</a>Although pulmonary endarterectomy surgery is not routinely available in our country, patients are fully reimbursed by the Portuguese Public National Health Service if surgery is performed abroad. Despite limitations associated with the need for a cross-border, high risk procedure, 42% of CTEPH patients had the operation in a foreign centre, thanks to a protocol for surgical treatment of PH established in 2000. Non-operable patients, patients refusing pulmonary endarterectomy, or patients with residual persistent PH after pulmonary endarterectomy were predominantly treated with monotherapy (57.7%) and specially with ERAs (46.2%), as per previous studies.<a class="elsevierStyleCrossRefs" href="#bib0420">39,40</a>In terms of clinical outcomes during the period of the study, WHO FC, 6MWD, mPAP and PVR significantly improved for the overall population, which is in line with the accumulating evidence of substantial gains in long-term prognosis obtained over recent decades, following the introduction of several therapeutic alternatives.<a class="elsevierStyleCrossRefs" href="#bib0240">3,30,32,34</a>Although usual bias for survival estimates were eliminated in this study (including mixed population of incident/prevalent cases and “immortal” bias), survival estimates should still be considered with caution since there were substantial changes in treatment strategies during the course of the study. Nonetheless, survival estimates found for the total cohort and PAH follow the trends of the most relevant international registries<a class="elsevierStyleCrossRefs" href="#bib0355">26–28,30,32,35</a>; the 1-year survival among CTEPH patients (81.5%) was considerably below estimates from other studies (88–97%),<a class="elsevierStyleCrossRefs" href="#bib0410">37–40</a> which could be connected to difficulties of access to PEA surgery.This study had several limitations. First, its single-centre nature might affect the representativeness of the findings for the overall Portuguese population, however, the study was conducted at one of the largest PH centres in the country, serving the northern region, with an ample and diverse group of patients currently being followed. Second, the relatively small sample size impaired the ability to perform more in-depth statistical analysis such as predictors of survival, however, in the context of a non-frequent disease the data provided by this study gives highly relevant insight to inform clinical practice. Third, the enrolment period for this study was long, which is associated with highly variable follow-up times and variable treatment approaches over time. Still, the low incidence of PH and the country/region dimension make enrolment over reduced periods difficult.ConclusionsThis study provides long-term, real-world data for the management of PH in Portugal. It also demonstrates the potential of a dedicated information system for PAH in generating high-quality real-world data aimed at characterising PH in present clinical practice conditions. Patients presented mostly with intermediate or high risk of mortality which might be indicative of delay in diagnosis and highlights the need to increase awareness and early referral to expert centres for this condition among clinicians.Conflicts of interestAbílio Reis is co-proprietary of the dedicated pulmonary hypertension software PAHTool®. The remaining authors have no conflicts of interests to disclose." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1090393" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1033674" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Medical care" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Assessments" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical methods" ] ] ] 4 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Study population and baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Treatment and clinical evolution" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Survival" ] ] ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 8 => array:2 [ "identificador" => "xack370388" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-29" "fechaAceptado" => "2018-02-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1033674" "palabras" => array:6 [ 0 => "Pulmonary hypertension" 1 => "Pulmonary arterial hypertension" 2 => "Survival" 3 => "Portuguese population" 4 => "Cohort" 5 => "Real-world data" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundPulmonary hypertension (PH) is a heterogeneous, debilitating condition with highly relevant impact on functional capacity, quality of life, and life-expectancy. ObjectivesThis study aims to provide long-term data on the Portuguese PH population, by characterising the clinical presentation, evolution, and outcomes of PH patients in a specialised referral centre. MethodsRetrospective analysis of a cohort of 101 patients with pre-capillary PH (pcPH) referenced to an expert tertiary care referral centre in northern Portugal from 2002 to 2013. Diagnosis was confirmed by right heart catheterisation (RHC). PH classification followed consensus criteria from the 5th World Symposium in Nice, 2013. ResultsThe most frequent causes of pcPH were Group 1 PH – pulmonary arterial hypertension (PAH) (54.4%) and Group 4 PH – Chronic thromboembolic pulmonary hypertension (CTEPH) (25.7%); importantly, 17.8% of patients presented PH associated with multiple aetiologies. Targeted therapy was used in 91.1% of patients (48.5% combination therapy). 1-, 3-, and 5-year survival was estimated at 86.6%, 76.7%, and 64.1%, respectively. Survival was significantly better for those ≤40 years old (10.5 vs. 6.4 years; P=0.003) and for women with I/HPAH (9.3 vs. 4.5 years; P=0.039). ConclusionsThis study provides long-term, real-world data for the management of PAH and CTEPH in Portugal and demonstrates the importance of dedicated electronic medical records and well defined clinical management protocols for better patient outcomes. Patients presented mostly with intermediate or high risk of mortality, which suggests delayed diagnosis and highlights the need to increase awareness among clinicians." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2167 "Ancho" => 2507 "Tamanyo" => 278226 ] ] "descripcion" => array:1 [ "en" => "The study cohort. PH: pulmonary hypertension; RHC: right heart catheterisation; PAH: pulmonary arterial hypertension; PH-lung: pulmonary hypertension associated with lung disease; CTEPH: chronic thromboembolic pulmonary hypertension; PH-misc: miscellaneous pulmonary hypertension." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1458 "Ancho" => 2326 "Tamanyo" => 133442 ] ] "descripcion" => array:1 [ "en" => "Change in functional capacity, measured by WHO FC, from first do last visit." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1264 "Ancho" => 1424 "Tamanyo" => 89719 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier survival curve for the overall study cohort, patients with PAH (Group 1 PH) and patients with CTEPH (Group 4 PH)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2465 "Ancho" => 1438 "Tamanyo" => 164353 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier survival curves for subgroups of patients, according to (A) subgroup of PAH and (B) CTEPH treatment." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Results are presented as mean±SD, except when otherwise indicated.IPAH: idiopathic pulmonary arterial hypertension; HPAH: heritable pulmonary arterial hypertension; CTD: connective tissue disease; CHD: congenital heart disease; CTEPH: chronic thromboembolic pulmonary hypertension; WHO FC: World Health Organization functional class; 6MWD: 6-min walk distance; NT-proBNP: N-terminal pro brain natriuretic peptide; mPAP: mean pulmonary artery pressure; PCWP: pulmonary capillary wedge pressure; RAP: right atrial pressure; CO: cardiac output; CI: cardiac index; PVR: pulmonary vascular resistance." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (n=101) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I/HPAH (n=18) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTD (n=11) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CHD (n=20) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTEPH (n=26) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.6±19.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.4±14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.6±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.1±14.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (66.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (81.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (55.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (69.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.466 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">WHO FC, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I/II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (39.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (45.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.220 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III/IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (60.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (70.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (69.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWT, m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">319.6±132.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">360.7±117.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">297.3±53.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">330.7±24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289.4±144.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.380 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NT-proBNP, pg/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1533.4±1758.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1543.8±1712.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2081.9±909.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1139.3±277.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2163.8±1805.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.349 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Haemodynamics</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">mPAP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.5±16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.9±17.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.3±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.6±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.6±7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PAWP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.0±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.79±4.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RAP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.2±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.9±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.092 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CO, L/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.73±1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.739 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CI, L/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.72±0.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.739 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PVR, WU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4±6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.87±2.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.076 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864336.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline demographic and clinical characteristics." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Results are presented as absolute frequency (percentage).IPAH: idiopathic pulmonary arterial hypertension; HPAH: heritable pulmonary arterial hypertension; CTD: connective tissue disease; CHD: congenital heart disease; CTEPH: chronic thromboembolic pulmonary hypertension; PDE-5I: phosphodiesterase-5 inhibitors; ERA: endothelin-1 receptor antagonists; NA: not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (n=101) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I/HPAH (n=18) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTD (n=11) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CHD (n=20) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTEPH (n=26) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Single targeted treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients under monotherapy only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (42.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (57.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDE-5I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ERA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (37.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (40.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (46.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Combination treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients under combination therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (48.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (88.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (55.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (42.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dual combination therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (27.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (30.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triple combination therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (61.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDE-5I+Prostanoids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostanoids+ERA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDE-5I+ERA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (40.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PDE-5I+Prostanoids+ERA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (61.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Surgical treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary endarterectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (42.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Conventional treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conventional therapy only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conventional plus targeted therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (91.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (100.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (90.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (100.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864337.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Medical and surgical treatment at the last follow-up visit." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Results are presented as mean±SD.6MWD: 6-min walk distance; NT-proBNP: N-terminal pro brain natriuretic peptide." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (n=101)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">I/HPAH (n=18)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTD (n=11)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CHD (n=20)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTEPH (n=26)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWD, m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">319.6±132.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">357.7±162.1<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">360.7±117.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">463.3±163.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">297.3±53.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">282.5±163.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">330.7±24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">319.8±164.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289.4±144 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">337.2±156.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NT-proBNP, pg/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1533.4±1758.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1963.9±3627.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1543.8±1712.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1583.2±3761.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2081.9±909.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3392.8±3732.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1139.3±277.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1815.9±3671.7<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2163.8±1805.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2960.1±5098.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864335.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<0.05." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<0.01." ] ] ] "descripcion" => array:1 [ "en" => "6MWD and NT-proBNP evolution from first to last visit." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PH: pulmonary hypertension; PAH: pulmonary arterial hypertension; CTEPH: chronic thromboembolic pulmonary hypertension. Survival estimates for subgroups of PH were not calculated due to limitations introduced by reduced sample size and variable follow-up times in the subgroups." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cumulative probability of survival, % \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Total cohort (n=101)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 year from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Group 1 PH – PAH (n=55)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 year from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Group 4 PH – CTEPH (n=26)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 year from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 years from diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864338.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier survival estimates." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0230" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "D42–D50" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Definitions and diagnosis of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Hoeper" 1 => "H.J. Bogaard" 2 => "R. Condliffe" 3 => "R. Frantz" 4 => "D. Khanna" 5 => "M. Kurzyna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.10.032" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2013" "volumen" => "62" "numero" => "25 Suppl." "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0235" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "D34–D41" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updated clinical classification of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Simonneau" 1 => "M.A. Gatzoulis" 2 => "I. Adatia" 3 => "D. Celermajer" 4 => "C. Denton" 5 => "A. Ghofrani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.10.029" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2013" "volumen" => "62" "numero" => "25 Suppl" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0240" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Endorse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galie" 1 => "M. Humbert" 2 => "J.-L. Vachiery" 3 => "S. Gibbs" 4 => "I. Lang" 5 => "A. Torbicki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv317" "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "volumen" => "46" "paginaInicial" => "903" "paginaFinal" => "975" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0245" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.V. McLaughlin" 1 => "S.J. Shah" 2 => "R. Souza" 3 => "M. Humbert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2015.03.540" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2015" "volumen" => "65" "paginaInicial" => "1976" "paginaFinal" => "1997" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25953750" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0250" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Sitbon" 1 => "M. Humbert" 2 => "X. Jais" 3 => "V. Ioos" 4 => "A.M. Hamid" 5 => "S. Provencher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.488486" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "111" "paginaInicial" => "3105" "paginaFinal" => "3111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15939821" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0255" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Rich" 1 => "E. Kaufmann" 2 => "P.S. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199207093270203" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1992" "volumen" => "327" "paginaInicial" => "76" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1603139" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0260" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ambrisentan for the treatment of pulmonary arterial hypertension: results of the ambrisentan in pulmonary arterial hypertension, randomized, double-blind, placebo-controlled, multicenter, efficacy (ARIES) study 1 and 2" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galie" 1 => "H. Olschewski" 2 => "R.J. Oudiz" 3 => "F. Torres" 4 => "A. Frost" 5 => "H.A. Ghofrani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.742510" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "117" "paginaInicial" => "3010" "paginaFinal" => "3019" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18506008" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0265" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.N. Channick" 1 => "G. Simonneau" 2 => "O. Sitbon" 3 => "I.M. Robbins" 4 => "A. Frost" 5 => "V.F. Tapson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(01)06250-X" "Revista" => array:5 [ "tituloSerie" => "Lancet (Lond, Engl)" "fecha" => "2001" "volumen" => "358" "paginaInicial" => "1119" "paginaFinal" => "1123" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0270" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Macitentan and morbidity and mortality in pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Pulido" 1 => "I. Adzerikho" 2 => "R.N. Channick" 3 => "M. Delcroix" 4 => "N. Galiè" 5 => "H.-A. Ghofrani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1213917" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "369" "paginaInicial" => "809" "paginaFinal" => "818" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23984728" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0275" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiproliferative effect of sildenafil on human pulmonary artery smooth muscle cells" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Tantini" 1 => "A. Manes" 2 => "E. Fiumana" 3 => "C. Pignatti" 4 => "C. Guarnieri" 5 => "R. Zannoli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00395-004-0504-5" "Revista" => array:6 [ "tituloSerie" => "Basic Res Cardiol" "fecha" => "2005" "volumen" => "100" "paginaInicial" => "131" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15739122" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0280" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical efficacy of sildenafil in primary pulmonary hypertension: a randomized, placebo-controlled, double-blind, crossover study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.K.S. Sastry" 1 => "C. Narasimhan" 2 => "N.K. Reddy" 3 => "B.S. Raju" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2003.10.056" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1149" "paginaFinal" => "1153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15063421" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0285" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PATENT PLUS: a blinded, randomised and extension study of riociguat plus sildenafil in pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Galie" 1 => "K. Muller" 2 => "A.-V. Scalise" 3 => "E. Grunig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00105914" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "1314" "paginaFinal" => "1322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25657022" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0290" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Riociguat for the treatment of pulmonary arterial hypertension: a long-term extension study (PATENT-2)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.J. Rubin" 1 => "N. Galie" 2 => "F. Grimminger" 3 => "E. Grunig" 4 => "M. Humbert" 5 => "Z.-C. Jing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00090614" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "1303" "paginaFinal" => "1313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614164" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0295" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Barst" 1 => "L.J. Rubin" 2 => "W.A. Long" 3 => "M.D. McGoon" 4 => "S. Rich" 5 => "D.B. Badesch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199602013340504" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1996" "volumen" => "334" "paginaInicial" => "296" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8532025" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0300" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Sitbon" 1 => "M. Humbert" 2 => "H. Nunes" 3 => "F. Parent" 4 => "G. Garcia" 5 => "P. Hervé" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2002" "volumen" => "40" "paginaInicial" => "780" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12204511" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0305" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled iloprost for severe pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Olschewski" 1 => "G. Simonneau" 2 => "N. Galie" 3 => "T. Higenbottam" 4 => "R. Naeije" 5 => "L.J. Rubin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa020204" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "347" "paginaInicial" => "322" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12151469" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0310" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Simonneau" 1 => "R.J. Barst" 2 => "N. Galie" 3 => "R. Naeije" 4 => "S. Rich" 5 => "R.C. Bourge" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.165.6.2106079" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2002" "volumen" => "165" "paginaInicial" => "800" "paginaFinal" => "804" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11897647" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0315" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selexipag: an oral, selective prostacyclin receptor agonist for the treatment of pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Simonneau" 1 => "A. Torbicki" 2 => "M.M. Hoeper" 3 => "M. Delcroix" 4 => "K. Karlocai" 5 => "N. Galie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00137511" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "874" "paginaFinal" => "880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22362844" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0320" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of beraprost sodium, an oral prostacyclin analogue, in patients with pulmonary arterial hypertension: a randomized, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galie" 1 => "M. Humbert" 2 => "J.-L. Vachiery" 3 => "C.D. Vizza" 4 => "M. Kneussl" 5 => "A. Manes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2002" "volumen" => "39" "paginaInicial" => "1496" "paginaFinal" => "1502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11985913" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0325" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Definition, epidemiology and registries of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Awdish" 1 => "H. Cajigas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10741-015-9510-y" "Revista" => array:2 [ "tituloSerie" => "Heart Fail Rev" "fecha" => "2015" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0330" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary hypertension in Portugal: first data from a nationwide registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Baptista" 1 => "J. Meireles" 2 => "A. Agapito" 3 => "G. Castro" 4 => "A.M. da Silva" 5 => "T. Shiang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/489574" "Revista" => array:5 [ "tituloSerie" => "Biomed Res Int" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "489574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24228252" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0335" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-world, long-term survival of incident patients with pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Marques-Alves" 1 => "R. Baptista" 2 => "A. Marinho da Silva" 3 => "M. Pêgo" 4 => "G. Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppnen.2017.01.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "124" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28283462" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0340" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of pulmonary hypertension patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Reis" 1 => "N. Rocha" 2 => "R. Barros" 3 => "A. Martins" 4 => "F. Oliveira" 5 => "A.N. Diogo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "253" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20545252" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0345" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial hypertension – experience of Centro Hospitalar de Vila Nova de Gaia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Oliveira" 1 => "D. Ferreira" 2 => "A. Caiado" 3 => "S. Ferreira" 4 => "P. Ferreira" 5 => "L. Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "239" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17492235" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0350" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "D51–D9" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial hypertension: epidemiology and registries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. McGoon" 1 => "R.L. Benza" 2 => "P. Escribano-Subias" 3 => "X. Jiang" 4 => "D.P. Miller" 5 => "A.J. Peacock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.10.023" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2013" "volumen" => "62" "numero" => "25 Suppl." "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0355" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.L. Benza" 1 => "D.P. Miller" 2 => "R.J. Barst" 3 => "D.B. Badesch" 4 => "A.E. Frost" 5 => "M.D. McGoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-1460" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "448" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22281797" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0360" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival in pulmonary hypertension in Spain: insights from the Spanish registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Escribano-Subias" 1 => "I. Blanco" 2 => "M. Lopez-Meseguer" 3 => "C.J. Lopez-Guarch" 4 => "A. Roman" 5 => "P. Morales" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00101211" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "596" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22362843" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0365" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Hoeper" 1 => "D. Huscher" 2 => "H.A. Ghofrani" 3 => "M. Delcroix" 4 => "O. Distler" 5 => "C. Schweiger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2012.10.026" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2013" "volumen" => "168" "paginaInicial" => "871" "paginaFinal" => "880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23164592" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0370" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Humbert" 1 => "O. Sitbon" 2 => "A. Yaici" 3 => "D. Montani" 4 => "D.S. O’Callaghan" 5 => "X. Jais" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00057010" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "549" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20562126" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0375" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ASPIRE registry: Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hurdman" 1 => "R. Condliffe" 2 => "C.A. Elliot" 3 => "C. Davies" 4 => "C. Hill" 5 => "J.M. Wild" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00078411" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "945" "paginaFinal" => "955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21885399" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0380" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registry and survival study in Chinese patients with idiopathic and familial pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.-C. Jing" 1 => "X.-Q. Xu" 2 => "Z.-Y. Han" 3 => "Y. Wu" 4 => "K.-W. Deng" 5 => "H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-2913" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "373" "paginaFinal" => "379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17400671" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0385" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Ling" 1 => "M.K. Johnson" 2 => "D.G. Kiely" 3 => "R. Condliffe" 4 => "C.A. Elliot" 5 => "J.S.R. Gibbs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201203-0383OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2012" "volumen" => "186" "paginaInicial" => "790" "paginaFinal" => "796" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22798320" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0390" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and survival of patients with pulmonary hypertension: a 40-month mean follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Lopez Reyes" 1 => "D. Nauffal Manzur" 2 => "A. Garcia Ortega" 3 => "M.A. Menendez Salinas" 4 => "E. Ansotegui Barrera" 5 => "B. Balerdi Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/crj.12312" "Revista" => array:2 [ "tituloSerie" => "Clin Respir J" "fecha" => "2015" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0395" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term data from the Swiss pulmonary hypertension registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Mueller-Mottet" 1 => "H. Stricker" 2 => "G. Domeninghetti" 3 => "A. Azzola" 4 => "T. Geiser" 5 => "M. Schwerzmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000370125" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2015" "volumen" => "89" "paginaInicial" => "127" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25661477" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0400" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Thenappan" 1 => "S.J. Shah" 2 => "S. Rich" 3 => "L. Tian" 4 => "S.L. Archer" 5 => "M. Gomberg-Maitland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00072709" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2010" "volumen" => "35" "paginaInicial" => "1079" "paginaFinal" => "1087" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20032020" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0405" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial hypertension in France: results from a national registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Humbert" 1 => "O. Sitbon" 2 => "A. Chaouat" 3 => "M. Bertocchi" 4 => "G. Habib" 5 => "V. Gressin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200510-1668OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2006" "volumen" => "173" "paginaInicial" => "1023" "paginaFinal" => "1030" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16456139" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0410" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension: a 1-year follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Hughes" 1 => "X. Jais" 2 => "D. Bonderman" 3 => "J. Suntharalingam" 4 => "M. Humbert" 5 => "I. Lang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00135905" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2006" "volumen" => "28" "paginaInicial" => "138" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16611652" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0415" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Condliffe" 1 => "D.G. Kiely" 2 => "J.S.R. Gibbs" 3 => "P.A. Corris" 4 => "A.J. Peacock" 5 => "D.P. Jenkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200712-1841OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2008" "volumen" => "177" "paginaInicial" => "1122" "paginaFinal" => "1127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18292468" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0420" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management and outcomes in chronic thromboembolic pulmonary hypertension: from expert centers to a nationwide perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Escribano-Subias" 1 => "R. Del Pozo" 2 => "A. Roman-Broto" 3 => "J.A. Domingo Morera" 4 => "A. Lara-Padron" 5 => "T. Elias Hernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2015.11.039" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2015" "volumen" => "203" "paginaInicial" => "938" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26618257" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0425" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi:2008/25/smw-11914" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary hypertension in Switzerland: treatment and clinical course" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Fischler" 1 => "R. Speich" 2 => "L. Dorschner" 3 => "L. Nicod" 4 => "G. Domenighetti" 5 => "M. Tamm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "2008/25/smw-11914" "Revista" => array:6 [ "tituloSerie" => "Swiss Med Wkly" "fecha" => "2008" "volumen" => "138" "paginaInicial" => "371" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18587689" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0430" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival in patients with primary pulmonary hypertension: results from a national prospective registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.E. D’Alonzo" 1 => "R.J. Barst" 2 => "S.M. Ayres" 3 => "E.H. Bergofsky" 4 => "B.H. Brundage" 5 => "K.M. Detre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1991" "volumen" => "115" "paginaInicial" => "343" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1863023" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0435" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival of Chinese patients with pulmonary arterial hypertension in the modern treatment era" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Zhang" 1 => "L.-Z. Dai" 2 => "W.-P. Xie" 3 => "Z.-X. Yu" 4 => "B.-X. Wu" 5 => "L. Pan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.10-2327" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "140" "paginaInicial" => "301" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21330386" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0440" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic pulmonary arterial hypertension and its prognosis in the modern management era in developed and developing countries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "X. Jiang" 1 => "M. Humbert" 2 => "Z.-C. Jing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000336068" "Libro" => array:3 [ "fecha" => "2012" "paginaInicial" => "85" "paginaFinal" => "93" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0445" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival in an incident cohort of patients with pulmonary arterial hypertension in Denmark" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Korsholm" 1 => "A. Andersen" 2 => "R.E. Kirkfeldt" 3 => "K.N. Hansen" 4 => "S. Mellemkjaer" 5 => "J.E. Nielsen-Kudsk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/681270" "Revista" => array:6 [ "tituloSerie" => "Pulm Circ" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "364" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26064463" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0450" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galiè" 1 => "J.A. Barberà" 2 => "A.E. Frost" 3 => "H.-A. Ghofrani" 4 => "M.M. Hoeper" 5 => "V.V. McLaughlin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1413687" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "834" "paginaFinal" => "844" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26308684" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack370388" "titulo" => "Acknowledgments" "texto" => "The authors would like to Tiago Campos (ARC Publishing) for providing medical writing assistance; these services were supported by an unrestricted grant from Actelion Pharmaceuticals." 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Pulmonary hypertension: Real-world data from a Portuguese expert referral centre

A. Gomesa, C. Cruza, J. Rochaa, M. Ricardoa, M. Vicenteb, A. Meloc, M. Santosc,d, L. Carvalhoa,c, F. Gonçalvesa,c, A. Reisc,

Corresponding author

reisabilio@gmail.com

Corresponding author at: Pulmonary Vascular Disease Unit, Centro Hospitalar do Porto – Hospital de Santo, António, 4099-001 Porto, Portugal.

a Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto – Hospital de Santo António, Porto, Portugal

b Department of Health Sciences, University of Aveiro, Aveiro, Portugal

c Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto Hospital de Santo António, Porto, Portugal

d Cardiology Service, Medicine Department, Centro Hospitalar do Porto – Hospital de Santo António, Porto, Portugal

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and includes idiopathic pulmonary arterial hypertension &#40;IPAH&#41;&#44; heritable pulmonary arterial hypertension &#40;HPAH&#41;&#44; and drugs and toxin induced&#59; PH associated with diseases such as connective tissue disease &#40;CTD&#41;&#44; HIV infection&#44; portal hypertension&#44; congenital heart disease &#40;CHD&#41; and schistosomiasis are also included in Group 1&#46; Group 1&#8242; and Group 1&#8243; refer to pulmonary veno-occlusive disease and&#47;or pulmonary capillary haemangiomatosis and persistent pulmonary hypertension of the newborn&#44; respectively&#46; Group 2 PH includes PH due to left heart disease &#40;LHD&#41;&#46; Group 3 refers to PH due to lung diseases or hypoxia&#44; such as chronic obstructive pulmonary disease &#40;COPD&#41; or interstitial lung disease&#46; Group 4 PH includes chronic thromboembolic pulmonary hypertension &#40;CTEPH&#41; and other pulmonary artery obstructions&#46; Group 5 refers to PH with unclear and&#47;or multifactorial mechanisms&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Group 1 &#40;PAH&#41; aetiologies&#44; except schistosomiasis associated PAH&#44; are considered rare diseases&#59; IPAH being an exclusion diagnosis&#44; is the most studied form of PAH and the model for clinical management of PAH forms which are indicated for targeted therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">3&#44;4</span></a> Treatment of PH involves both conventional&#44; symptom-based therapy and targeted therapy&#44; which is indicated for specific PH aetiologies&#46; Conventional treatment involves the use of digoxin to improve right ventricular function&#44; diuretics to reduce peripheral oedema&#44; supplemental oxygen&#44; and in specific cases anticoagulants&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a> Calcium channel blockers &#40;CCBs&#41; can be used to lower PAP&#44; but their use is restricted to a small percentage of patients &#40;3&#8211;5&#37;&#41; showing positive response to acute pulmonary vasodilator &#40;ARVT&#41; challenge&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">5&#44;6</span></a> Targeted therapy includes the use of endothelin-1 receptor antagonists &#40;ERA&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">7&#8211;9</span></a> phosphodiesterase-5 inhibitors &#40;PDE-5I&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">10&#44;11</span></a> soluble guanylate cyclase &#40;sGC&#41; stimulators&#44;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">12&#44;13</span></a> and prostacyclin analogues or receptor agonists&#44;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">14&#8211;19</span></a> surgical treatment&#44; like lung or heart-lung transplantation is reserved to refractory cases of PAH&#59; pulmonary angioplasty and pulmonary endarterectomy is reserved to CTEPH patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The proliferation of studies assessing long-term prognosis of PH has helped identify considerably different patients and disease characteristics both over time and for populations in different geographical regions&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a> These findings suggest the need for specific regional data&#44; to fully characterise local disease populations&#44; inform clinical practice&#44; and to help define local&#47;regional political strategies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Portugal&#44; a national PH registry has been&#44; but given its recent implementation&#44; only short-term data have been published&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> Recently&#44; another study characterised the survival over a longer follow-up period but the sample size remained relatively small &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This study aims to provide long-term data for the Portuguese PH population&#44; by characterising the clinical presentation&#44; evolution&#44; and outcomes of PH patients in a specialised referral centre in Portugal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective analysis of a cohort of PH patients referenced to an expert tertiary care referral centre in northern Portugal &#40;Pulmonary Vascular Disease Unit&#44; Centro Hospitalar do Porto &#8211; Hospital de Santo Ant&#243;nio&#44; Porto&#44; Portugal&#41; from 2002 to 2013&#46; At this centre&#44; patients followed a defined protocol for the clinical management of PH&#44; which was adjusted to the applicable national<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a> and international guidelines during the period of the study&#46; The protocol specified mandatory clinical assessments&#44; which were prospectively collected in dedicated PH software developed by the centre &#40;PAHTool<span class="elsevierStyleSup">&#174;</span>&#44; Inovultus Lda&#44; Santa Maria da Feira&#44; Portugal&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">PH was confirmed by right heart catheterisation &#40;RHC&#41;&#44; with a mean pulmonary artery pressure &#40;mPAP&#41; &#8805;25<span class="elsevierStyleHsp" style=""></span>mmHg&#59; pulmonary arterial wedge pressure &#40;PAWP&#41; &#8804;15<span class="elsevierStyleHsp" style=""></span>mmHg was used to define pre-capillary PH&#46; For the purposes of this study&#44; clinical classification of PH followed standard criteria according to the consensus from the 5th World Symposium in Nice&#44; 2013&#46; Patients with left heart disease &#40;LHD&#41; &#40;Group 2 PH&#41; were not included in this study&#44; due to the significantly different pathophysiology&#44; treatment approaches&#44; and prognosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the ethics committee of Hospital de Santo Ant&#243;nio&#44; Porto&#44; Portugal&#46; All patients provided their written informed consent prior to enrolment in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Medical care</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients received standard medical care throughout the period of the study&#46; Treatment was prescribed by the accompanying physician based on national and international guidelines applicable at time of the study &#40;as defined in the protocol implemented at the centre&#41; and local treatment availability&#46; Overall&#44; all patients received standard conventional treatment when clinically indicated&#44; including anticoagulants&#44; diuretics&#44; digoxin&#44; oxygen supplementation&#44; and high dose calcium channel blockers &#40;CCBs&#41; &#40;if they were AVRT responders&#41;&#46; Selected patients received molecular targeted therapy in addition to conventional therapy&#44; including endothelin-1 receptor antagonists &#40;ERA&#41;&#44; phosphodiesterase-5 inhibitors &#40;PDE-5I&#41;&#44; and prostacyclin analogues&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Assessments</span><p id="par0050" class="elsevierStylePara elsevierViewall">Demographic characteristics &#40;gender and age&#41; and clinical characteristics &#40;PH aetiology&#44; symptoms&#44; WHO functional class&#44; 6-min walking test &#40;6MWT&#41;&#44; N-terminal pro brain natriuretic peptide &#40;NT-proBNP&#41;&#44; and haemodynamic parameters&#41; were collected at baseline&#46; According to the protocol implemented at the centre&#44; patients attended&#44; routinely&#44; 3&#8211;4 visits per year or if they had any sign of deterioration&#46; During follow-up the following assessments were considered mandatory&#58; type of treatment administered&#44; clinical evaluation focused on signs of deterioration &#40;like heart failure or syncope&#41;&#44; WHO functional class&#44; 6MWT&#44; and NT-proBNP&#59; and yearly haemodynamic re-evaluation&#46; Survival was established based on the electronic medical records &#40;EMR&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Statistical methods</span><p id="par0055" class="elsevierStylePara elsevierViewall">Demographic and clinical variables were summarised with descriptive statistics&#46; Categorical variables were summarised as absolute frequency and percentage&#44; whereas continuous variables were summarised as mean and standard deviation &#40;SD&#41;&#46; Student&#39;s <span class="elsevierStyleItalic">t</span>&#44; Wilcoxon&#39;s&#44; Fisher&#39;s exact&#44; or chi-square tests were used to conduct paired&#47;independent univariate&#47;bivariate analysis as appropriate&#46; Cumulative survival was estimated using the Kaplan&#8211;Meier method&#46; Patients were censored at the end of the study&#44; except for those who underwent lung transplantation&#44; censored at the time of transplantation&#46; Differences between the survival curves &#40;according to baseline characteristics and disease aetiology&#41; were analysed using the log-rank test&#46; A 5&#37; significance level was employed for all analyses&#46; For the purpose of subgroup analysis patients with multiple aetiology were excluded from any subgroup analysis&#44; except those for whom CTEPH was considered their main diagnosis&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Data was retrieved from PAHTool<span class="elsevierStyleSup">&#174;</span>&#46; Statistical analysis was conducted using IBM SPSS Statistics for Windows&#44; Version 21&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population and baseline characteristics</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the enrolment period of the study&#44; a total of 211 patients with suspected PH were referenced to the Pulmonary Vascular Disease Unit &#40;PDVU&#41;&#46; RHC confirmed PH in 120 patients&#44; of which&#44; 19 were excluded from the analysis &#40;10 patients lost to follow-up and 9 patients with exclusive left heart disease&#41;&#44; leading to a final study cohort of 101 patients with pcPH&#46; The majority of patients represented incident cases &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>81&#44; 80&#46;2&#37;&#41;&#44; however&#44; 20 &#40;19&#46;8&#37;&#41; patients had a prior diagnosis of congenital heart diseases before referral&#44; having started specific therapy at admission to the centre&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents the patient disposition in the study cohort&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD follow-up time in the overall study population was 3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7 years&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the baseline demographic and clinical characteristics of the study population&#46; Approximately 66&#46;3&#37; of patients were female &#40;3&#58;1 ratio&#41; and the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD age at baseline was 49&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;6 years&#46; Most participants showed moderate to severe disease manifestations at baseline&#44; with 60&#46;4&#37; of patients presenting in WHO functional classes &#40;FC&#41; III or IV&#44; with a mean NT-proBNP level of 1533&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1758&#46;3<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#44; and walking a mean distance of 319&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>132&#46;9<span class="elsevierStyleHsp" style=""></span>m on 6MWT&#46; Haemodynamically&#44; patients showed increased mPAP of 48&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5<span class="elsevierStyleHsp" style=""></span>mmHg&#44; increased PVR of 8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8 wood units&#44; increased RAP 11&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3<span class="elsevierStyleHsp" style=""></span>mmHg&#44; and normal CI of 3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1<span class="elsevierStyleHsp" style=""></span>L&#47;min&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The most frequent causes of PH were Group 1 PH &#8211; PAH &#40;54&#46;4&#37;&#41; and Group 4 PH &#8211; CTEPH &#40;25&#46;7&#37;&#41;&#59; from the PAH subgroup&#44; CHD &#40;36&#46;3&#37;&#41; was the most frequent&#44; followed by I&#47;HPAH &#40;32&#46;7&#37;&#41;&#44; and CTD &#40;20&#46;0&#37;&#41;&#59; importantly&#44; 17&#46;8&#37; of patients presented PH of multiple aetiology&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Concerning the most frequent PH subgroups&#44; I&#47;HPAH and CHD patients were younger &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; for all subgroups of aetiologies most patients presented with WHO FC III&#47;IV&#44; but patients with CHD and CTEPH showed significantly &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; worst functional capacity at baseline&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Treatment and clinical evolution</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows PH treatment used at the last follow-up visit&#46; All patients received conventional treatment during the period of the study&#44; with 8&#46;9&#37; of those receiving conventional therapy only&#46; Targeted therapy was used with 91&#46;1&#37; of participants in addition to conventional therapy&#46; 4 &#40;6&#46;8&#37;&#41; I&#47;HPAH patients were AVRT responders&#44; but only 2 were long-term responders&#44; being treated with high doses of CCBs only&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Single targeted therapy was used in 42&#46;6&#37; of patients&#44; dual combination therapy in 29&#46;7&#37;&#44; and triple combination therapy in 18&#46;8&#37;&#46; 42&#46;3&#37; of CTEPH patients underwent pulmonary endarterectomy during the course of the study&#46; The majority of patients with I&#47;HPAH were under combination therapy &#40;88&#46;9&#37;&#41;&#44; with 61&#46;1&#37; under triple therapy&#46; Most patients with CTD &#40;54&#46;4&#37;&#41; and CHD &#40;55&#46;0&#37;&#41; were under combination therapy&#44; and dual therapy was the most frequent type of treatment &#40;36&#46;4&#37; and 45&#46;0&#37;&#44; respectively&#41;&#46; Patients with non-operable CTEPH or with residual persistent PH were mostly under monotherapy &#40;57&#46;7&#37;&#41;&#44; particularly with ERAs &#40;46&#46;2&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">During patient follow-up&#44; functional capacity improved significantly &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; from first to last visit for the overall study population&#44; as illustrated in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Mean 6MWD significantly improved in the overall population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; and in the subgroup of I&#47;HPAH patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46; CHD subgroup was the only one to show a significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;040&#41; improvement in NT-proBNP levels &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">There was a significant reduction in mPAP in the overall population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and in the subgroup of I&#47;HPAH patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#46; PVR significantly improved in the overall population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41; and in the subgroup of I&#47;HPAH patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#46; No significant changes were observed in RAP and CI for either the overall population or subgroup analyses&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Survival</span><p id="par0105" class="elsevierStylePara elsevierViewall">During the follow-up period&#44; a total of 28 &#40;27&#46;7&#37;&#41; patients died of PH-related causes&#59; 10&#46;7&#37; of deaths occurred in patients with I&#47;HPAH&#44; 25&#46;0&#37; with CTEPH&#44; 10&#46;7&#37; with CTD&#44; and 25&#46;0&#37; with CHD&#46; Patients with WHO FC III or IV at baseline represented 67&#46;9&#37; of deaths&#46; Median survival time from diagnosis by RHC for the 28 deaths was 3&#46;1 years&#46; At the time of death 35&#46;7&#37; of patients were under monotherapy&#44; 39&#46;3&#37; under dual therapy&#44; 17&#46;9&#37; under triple therapy&#44; and only 2 patients &#40;7&#46;1&#37;&#41; were under exclusive conventional therapy&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents survival estimates for the overall study cohort and specific PH aetiologies&#46; For the overall study cohort&#44; 1-&#44; 3-&#44; and 5-year survival was estimated at 86&#46;6&#37;&#44; 76&#46;7&#37;&#44; and 64&#46;1&#37;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the Kaplan&#8211;Meier survival curve for the overall cohort and for patients with PAH vs&#46; CTEPH&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows specific Kaplan&#8211;Meier survival curves for subgroups of PAH &#40;A&#41; and according to CTEPH treatment &#40;B&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Survival was significantly better for those &#8804;40 years old &#40;10&#46;5 vs&#46; 6&#46;4 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; and in women with I&#47;HPAH compared with men &#40;9&#46;3 vs&#46; 4&#46;5 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;039&#41;&#59; no other significant differences in survival were observed for gender&#44; age&#44; PH aetiology&#44; and functional capacity analyses for the overall population and subgroups of aetiologies&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">This study provides long-term data for patient phenotypes&#44; clinical evolution&#44; and survival in PAH and CTEPH of a Portuguese PH population&#46; These results build on previous findings<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;24</span></a> and together they characterise the impact of this life-threatening disease in Portugal&#46; The present study enrolled only patients with pcPH due to the substantially different disease characteristics and treatment approaches that could bias the results and ultimately hinder comparisons with other cohorts published over the years&#46; Unlike previous studies&#44; here we included patients with all types of PH&#44; except for left heart disease&#44; to provide a more accurate picture of pcPH as a whole&#46; Left heart disease was the only PH group excluded from the analysis&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The PH dedicated software developed by the centre allowed the implementation of a mandatory case report form &#40;CRF&#41; with automatic alerts to avoid missing data in our clinical records&#46; This methodology allowed us to build a true real-world cohort of PH patients from our region and following the most recent Nice recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a> This is particularly relevant because PAHTool<span class="elsevierStyleSup">&#174;</span> is currently licenced for implementation in several PH centres worldwide&#44; and its widespread use is envisioned to allow the generation of relevant real-world data&#44; which is badly needed in the context of this non-frequent condition but rapidly evolving field&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">According to existing registries&#44; some aetiologies are underrepresented in our cohort &#40;particularly drugs and toxins induced PH&#44; HIV and portal hypertension associated PH&#41;&#44; which is most likely due to low physician awareness about PH&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;26&#8211;36</span></a> CHD &#40;36&#46;3&#37; of PAH group&#41; contributed with a comparatively higher proportion of cases&#44; which can be explained by the past low levels of detection and correction of heart defects in infancy in our country and by the fact that our centre was for a long time the only one to provide targeted therapy for PAH in the region&#46; CTEPH was the most frequent aetiology after PAH&#44; confirming the high prevalence of this frequently forgotten condition and in line with studies that included this subgroup of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;34&#44;37&#8211;39</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Comparing our data with the most important registries in the field&#44; we found that CTEPH age at diagnosis in our population is consistent with these registries<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">38&#8211;40</span></a>&#59; although the mean age at diagnosis for our overall population is similar to the majority of PAH registries<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">26&#44;29&#44;32</span></a> the mean age for I&#47;HPAH is clearly lower and near the pioneer registries<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">35&#44;41</span></a> and those coming from the developing world&#44;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">42&#44;43</span></a> but still in line with national data&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> Female gender &#40;66&#37;&#41; predominance is also in line with the majority of PH registries and cohorts&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;26&#8211;35</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Baseline clinical characteristics at presentation indicate some delay in diagnosis&#44; with most patients presenting with intermediate or high risk of mortality indicated by high NYHA FC&#44; low 6MWD and high NT-proBNP according to risk assessment guidelines<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a>&#59; increased RAP &#40;11&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and PVR &#40;8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<span class="elsevierStyleHsp" style=""></span>WU&#41; are also consistent with these findings&#46; The proportion of patients presenting with intermediate or high risk explains why the great majority of patients were treated with combination therapy&#58; I&#47;HPAH &#40;88&#46;9&#37;&#41;&#44; CTD &#40;54&#46;5&#37;&#41; and CHD &#40;55&#46;0&#37;&#41;&#46; These findings are&#44; however&#44; above what has been reported in recent European studies&#44; as well as national data&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;30&#44;32&#44;34&#44;44</span></a> There is a particularly high proportion of I&#47;HPAH &#40;61&#46;1&#37;&#41; patients under triple therapy&#44; which is probably the result of the close follow-up adopted and continuous risk evaluation with early step up of the therapy&#46; ERAs and PDE-5I were the most widely used drugs&#44; which is in accordance with previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">21&#44;30&#44;32&#44;34&#44;44</span></a> Still&#44; they were used far more frequently in combination than what has been reported&#44; which is in line with the most recent recommendations for the early use of sequential or upfront double combination therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">3&#44;45</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Although pulmonary endarterectomy surgery is not routinely available in our country&#44; patients are fully reimbursed by the Portuguese Public National Health Service if surgery is performed abroad&#46; Despite limitations associated with the need for a cross-border&#44; high risk procedure&#44; 42&#37; of CTEPH patients had the operation in a foreign centre&#44; thanks to a protocol for surgical treatment of PH established in 2000&#46; Non-operable patients&#44; patients refusing pulmonary endarterectomy&#44; or patients with residual persistent PH after pulmonary endarterectomy were predominantly treated with monotherapy &#40;57&#46;7&#37;&#41; and specially with ERAs &#40;46&#46;2&#37;&#41;&#44; as per previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">39&#44;40</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In terms of clinical outcomes during the period of the study&#44; WHO FC&#44; 6MWD&#44; mPAP and PVR significantly improved for the overall population&#44; which is in line with the accumulating evidence of substantial gains in long-term prognosis obtained over recent decades&#44; following the introduction of several therapeutic alternatives&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">3&#44;30&#44;32&#44;34</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Although usual bias for survival estimates were eliminated in this study &#40;including mixed population of incident&#47;prevalent cases and &#8220;immortal&#8221; bias&#41;&#44; survival estimates should still be considered with caution since there were substantial changes in treatment strategies during the course of the study&#46; Nonetheless&#44; survival estimates found for the total cohort and PAH follow the trends of the most relevant international registries<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">26&#8211;28&#44;30&#44;32&#44;35</span></a>&#59; the 1-year survival among CTEPH patients &#40;81&#46;5&#37;&#41; was considerably below estimates from other studies &#40;88&#8211;97&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">37&#8211;40</span></a> which could be connected to difficulties of access to PEA surgery&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">This study had several limitations&#46; First&#44; its single-centre nature might affect the representativeness of the findings for the overall Portuguese population&#44; however&#44; the study was conducted at one of the largest PH centres in the country&#44; serving the northern region&#44; with an ample and diverse group of patients currently being followed&#46; Second&#44; the relatively small sample size impaired the ability to perform more in-depth statistical analysis such as predictors of survival&#44; however&#44; in the context of a non-frequent disease the data provided by this study gives highly relevant insight to inform clinical practice&#46; Third&#44; the enrolment period for this study was long&#44; which is associated with highly variable follow-up times and variable treatment approaches over time&#46; Still&#44; the low incidence of PH and the country&#47;region dimension make enrolment over reduced periods difficult&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study provides long-term&#44; real-world data for the management of PH in Portugal&#46; It also demonstrates the potential of a dedicated information system for PAH in generating high-quality real-world data aimed at characterising PH in present clinical practice conditions&#46; Patients presented mostly with intermediate or high risk of mortality which might be indicative of delay in diagnosis and highlights the need to increase awareness and early referral to expert centres for this condition among clinicians&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">Ab&#237;lio Reis is co-proprietary of the dedicated pulmonary hypertension software PAHTool<span class="elsevierStyleSup">&#174;</span>&#46; The remaining authors have no conflicts of interests to disclose&#46;</p></span></span>"
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    "fechaRecibido" => "2017-08-29"
    "fechaAceptado" => "2018-02-04"
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            0 => "Pulmonary hypertension"
            1 => "Pulmonary arterial hypertension"
            2 => "Survival"
            3 => "Portuguese population"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulmonary hypertension &#40;PH&#41; is a heterogeneous&#44; debilitating condition with highly relevant impact on functional capacity&#44; quality of life&#44; and life-expectancy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study aims to provide long-term data on the Portuguese PH population&#44; by characterising the clinical presentation&#44; evolution&#44; and outcomes of PH patients in a specialised referral centre&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of a cohort of 101 patients with pre-capillary PH &#40;pcPH&#41; referenced to an expert tertiary care referral centre in northern Portugal from 2002 to 2013&#46; Diagnosis was confirmed by right heart catheterisation &#40;RHC&#41;&#46; PH classification followed consensus criteria from the 5th World Symposium in Nice&#44; 2013&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The most frequent causes of pcPH were Group 1 PH &#8211; pulmonary arterial hypertension &#40;PAH&#41; &#40;54&#46;4&#37;&#41; and Group 4 PH &#8211; Chronic thromboembolic pulmonary hypertension &#40;CTEPH&#41; &#40;25&#46;7&#37;&#41;&#59; importantly&#44; 17&#46;8&#37; of patients presented PH associated with multiple aetiologies&#46; Targeted therapy was used in 91&#46;1&#37; of patients &#40;48&#46;5&#37; combination therapy&#41;&#46; 1-&#44; 3-&#44; and 5-year survival was estimated at 86&#46;6&#37;&#44; 76&#46;7&#37;&#44; and 64&#46;1&#37;&#44; respectively&#46; Survival was significantly better for those &#8804;40 years old &#40;10&#46;5 vs&#46; 6&#46;4 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; and for women with I&#47;HPAH &#40;9&#46;3 vs&#46; 4&#46;5 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;039&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study provides long-term&#44; real-world data for the management of PAH and CTEPH in Portugal and demonstrates the importance of dedicated electronic medical records and well defined clinical management protocols for better patient outcomes&#46; Patients presented mostly with intermediate or high risk of mortality&#44; which suggests delayed diagnosis and highlights the need to increase awareness among clinicians&#46;</p></span>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study cohort&#46; PH&#58; pulmonary hypertension&#59; RHC&#58; right heart catheterisation&#59; PAH&#58; pulmonary arterial hypertension&#59; PH-lung&#58; pulmonary hypertension associated with lung disease&#59; CTEPH&#58; chronic thromboembolic pulmonary hypertension&#59; PH-misc&#58; miscellaneous pulmonary hypertension&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Change in functional capacity&#44; measured by WHO FC&#44; from first do last visit&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier survival curve for the overall study cohort&#44; patients with PAH &#40;Group 1 PH&#41; and patients with CTEPH &#40;Group 4 PH&#41;&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier survival curves for subgroups of patients&#44; according to &#40;A&#41; subgroup of PAH and &#40;B&#41; CTEPH treatment&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results are presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#44; except when otherwise indicated&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IPAH&#58; idiopathic pulmonary arterial hypertension&#59; HPAH&#58; heritable pulmonary arterial hypertension&#59; CTD&#58; connective tissue disease&#59; CHD&#58; congenital heart disease&#59; CTEPH&#58; chronic thromboembolic pulmonary hypertension&#59; WHO FC&#58; World Health Organization functional class&#59; 6MWD&#58; 6-min walk distance&#59; NT-proBNP&#58; N-terminal pro brain natriuretic peptide&#59; mPAP&#58; mean pulmonary artery pressure&#59; PCWP&#58; pulmonary capillary wedge pressure&#59; RAP&#58; right atrial pressure&#59; CO&#58; cardiac output&#59; CI&#58; cardiac index&#59; PVR&#58; pulmonary vascular resistance&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I&#47;HPAH<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CHD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTEPH<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;81&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;55&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;466&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">WHO FC&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&#47;II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;39&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;30&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&#47;IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;70&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;69&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">6MWT&#44; m</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">319&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>132&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">360&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>117&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">297&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">330&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>144&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NT-proBNP&#44; pg&#47;mL</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1533&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1758&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1543&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1712&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2081&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>909&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1139&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>277&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2163&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1805&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Haemodynamics</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>mPAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PAWP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CO&#44; L&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;739&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CI&#44; L&#47;min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;076&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results are presented as absolute frequency &#40;percentage&#41;&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IPAH&#58; idiopathic pulmonary arterial hypertension&#59; HPAH&#58; heritable pulmonary arterial hypertension&#59; CTD&#58; connective tissue disease&#59; CHD&#58; congenital heart disease&#59; CTEPH&#58; chronic thromboembolic pulmonary hypertension&#59; PDE-5I&#58; phosphodiesterase-5 inhibitors&#59; ERA&#58; endothelin-1 receptor antagonists&#59; NA&#58; not applicable&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I&#47;HPAH<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CHD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Single targeted treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patients under monotherapy only&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#46;5&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ERA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;37&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Combination treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patients under combination therapy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;55&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;42&#46;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dual combination therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#46;8&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Triple combination therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#46;5&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDE-5I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Prostanoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prostanoids<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;15&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDE-5I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;15&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDE-5I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Prostanoids<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Surgical treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonary endarterectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;42&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Conventional treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conventional therapy only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conventional plus targeted therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;91&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;90&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Medical and surgical treatment at the last follow-up visit&#46;</p>"
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        "etiqueta" => "Table 3"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Results are presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">6MWD&#58; 6-min walk distance&#59; NT-proBNP&#58; N-terminal pro brain natriuretic peptide&#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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Overall &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">I&#47;HPAH<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CHD<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTEPH<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWD&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">319&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>132&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">357&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>162&#46;1<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="table-entry  " align="char" valign="top">360&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>117&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">463&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>163&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">297&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">282&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>163&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">330&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">319&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>164&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>144&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">337&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>156&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NT-proBNP&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1533&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1758&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1963&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3627&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1543&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1712&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1583&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3761&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2081&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>909&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3392&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3732&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1139&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>277&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1815&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3671&#46;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2163&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1805&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2960&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5098&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">&#60;0&#46;05&#46;</p>"
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              "identificador" => "tblfn0010"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">6MWD and NT-proBNP evolution from first to last visit&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">PH&#58; pulmonary hypertension&#59; PAH&#58; pulmonary arterial hypertension&#59; CTEPH&#58; chronic thromboembolic pulmonary hypertension&#46; Survival estimates for subgroups of PH were not calculated due to limitations introduced by reduced sample size and variable follow-up times in the subgroups&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cumulative probability of survival&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Total cohort &#40;n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">101&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 year from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Group 1 PH &#8211; PAH &#40;n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">55&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 year from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Group 4 PH &#8211; CTEPH &#40;n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">26&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 year from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5 years from diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
              "identificador" => "bib0230"
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                0 => array:3 [
                  "comentario" => "D42&#8211;D50"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Definitions and diagnosis of pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Hoeper"
                            1 => "H&#46;J&#46; Bogaard"
                            2 => "R&#46; Condliffe"
                            3 => "R&#46; Frantz"
                            4 => "D&#46; Khanna"
                            5 => "M&#46; Kurzyna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.10.032"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "numero" => "25 Suppl&#46;"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "D34&#8211;D41"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated clinical classification of pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Simonneau"
                            1 => "M&#46;A&#46; Gatzoulis"
                            2 => "I&#46; Adatia"
                            3 => "D&#46; Celermajer"
                            4 => "C&#46; Denton"
                            5 => "A&#46; Ghofrani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.10.029"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "numero" => "25 Suppl"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2015 ESC&#47;ERS Guidelines for the diagnosis and treatment of pulmonary hypertension&#58; The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology &#40;ESC&#41; and the European Respiratory Society &#40;ERS&#41; Endorse"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Galie"
                            1 => "M&#46; Humbert"
                            2 => "J&#46;-L&#46; Vachiery"
                            3 => "S&#46; Gibbs"
                            4 => "I&#46; Lang"
                            5 => "A&#46; Torbicki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehv317"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2015"
                        "volumen" => "46"
                        "paginaInicial" => "903"
                        "paginaFinal" => "975"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of pulmonary arterial hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;V&#46; McLaughlin"
                            1 => "S&#46;J&#46; Shah"
                            2 => "R&#46; Souza"
                            3 => "M&#46; Humbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2015.03.540"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2015"
                        "volumen" => "65"
                        "paginaInicial" => "1976"
                        "paginaFinal" => "1997"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25953750"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Sitbon"
                            1 => "M&#46; Humbert"
                            2 => "X&#46; Jais"
                            3 => "V&#46; Ioos"
                            4 => "A&#46;M&#46; Hamid"
                            5 => "S&#46; Provencher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.104.488486"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "111"
                        "paginaInicial" => "3105"
                        "paginaFinal" => "3111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15939821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Rich"
                            1 => "E&#46; Kaufmann"
                            2 => "P&#46;S&#46; Levy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199207093270203"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1992"
                        "volumen" => "327"
                        "paginaInicial" => "76"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1603139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambrisentan for the treatment of pulmonary arterial hypertension&#58; results of the ambrisentan in pulmonary arterial hypertension&#44; randomized&#44; double-blind&#44; placebo-controlled&#44; multicenter&#44; efficacy &#40;ARIES&#41; study 1 and 2"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Galie"
                            1 => "H&#46; Olschewski"
                            2 => "R&#46;J&#46; Oudiz"
                            3 => "F&#46; Torres"
                            4 => "A&#46; Frost"
                            5 => "H&#46;A&#46; Ghofrani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.107.742510"
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2008"
                        "volumen" => "117"
                        "paginaInicial" => "3010"
                        "paginaFinal" => "3019"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18506008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            7 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension&#58; a randomised placebo-controlled study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;N&#46; Channick"
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                            2 => "O&#46; Sitbon"
                            3 => "I&#46;M&#46; Robbins"
                            4 => "A&#46; Frost"
                            5 => "V&#46;F&#46; Tapson"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(01)06250-X"
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                        "tituloSerie" => "Lancet &#40;Lond&#44; Engl&#41;"
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                        "paginaInicial" => "1119"
                        "paginaFinal" => "1123"
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              "identificador" => "bib0270"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Macitentan and morbidity and mortality in pulmonary arterial hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Pulido"
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                            2 => "R&#46;N&#46; Channick"
                            3 => "M&#46; Delcroix"
                            4 => "N&#46; Gali&#232;"
                            5 => "H&#46;-A&#46; Ghofrani"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1213917"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "809"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23984728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antiproliferative effect of sildenafil on human pulmonary artery smooth muscle cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Tantini"
                            1 => "A&#46; Manes"
                            2 => "E&#46; Fiumana"
                            3 => "C&#46; Pignatti"
                            4 => "C&#46; Guarnieri"
                            5 => "R&#46; Zannoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00395-004-0504-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Basic Res Cardiol"
                        "fecha" => "2005"
                        "volumen" => "100"
                        "paginaInicial" => "131"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15739122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0280"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical efficacy of sildenafil in primary pulmonary hypertension&#58; a randomized&#44; placebo-controlled&#44; double-blind&#44; crossover study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            3 => "B&#46;S&#46; Raju"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2003.10.056"
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2004"
                        "volumen" => "43"
                        "paginaInicial" => "1149"
                        "paginaFinal" => "1153"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15063421"
                            "web" => "Medline"
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              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PATENT PLUS&#58; a blinded&#44; randomised and extension study of riociguat plus sildenafil in pulmonary arterial hypertension"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1183/09031936.00105914"
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                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "45"
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                        "paginaFinal" => "1322"
                        "link" => array:1 [
                          0 => array:2 [
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                            2 => "F&#46; Grimminger"
                            3 => "E&#46; Grunig"
                            4 => "M&#46; Humbert"
                            5 => "Z&#46;-C&#46; Jing"
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                    0 => array:2 [
                      "doi" => "10.1183/09031936.00090614"
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                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2015"
                        "volumen" => "45"
                        "paginaInicial" => "1303"
                        "paginaFinal" => "1313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614164"
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                    0 => array:2 [
                      "titulo" => "A comparison of continuous intravenous epoprostenol &#40;prostacyclin&#41; with conventional therapy for primary pulmonary hypertension"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Barst"
                            1 => "L&#46;J&#46; Rubin"
                            2 => "W&#46;A&#46; Long"
                            3 => "M&#46;D&#46; McGoon"
                            4 => "S&#46; Rich"
                            5 => "D&#46;B&#46; Badesch"
                          ]
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                    0 => array:2 [
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1996"
                        "volumen" => "334"
                        "paginaInicial" => "296"
                        "paginaFinal" => "301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8532025"
                            "web" => "Medline"
                          ]
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              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Long-term intravenous epoprostenol infusion in primary pulmonary hypertension&#58; prognostic factors and survival"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Sitbon"
                            1 => "M&#46; Humbert"
                            2 => "H&#46; Nunes"
                            3 => "F&#46; Parent"
                            4 => "G&#46; Garcia"
                            5 => "P&#46; Herv&#233;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
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                        "volumen" => "40"
                        "paginaInicial" => "780"
                        "paginaFinal" => "788"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12204511"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Inhaled iloprost for severe pulmonary hypertension"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Olschewski"
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                            3 => "T&#46; Higenbottam"
                            4 => "R&#46; Naeije"
                            5 => "L&#46;J&#46; Rubin"
                          ]
                        ]
                      ]
                    ]
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2002"
                        "volumen" => "347"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12151469"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous subcutaneous infusion of treprostinil&#44; a prostacyclin analogue&#44; in patients with pulmonary arterial hypertension&#58; a double-blind&#44; randomized&#44; placebo-controlled trial"
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                        0 => array:2 [
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                            1 => "R&#46;J&#46; Barst"
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                            3 => "R&#46; Naeije"
                            4 => "S&#46; Rich"
                            5 => "R&#46;C&#46; Bourge"
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "volumen" => "165"
                        "paginaInicial" => "800"
                        "paginaFinal" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11897647"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Selexipag&#58; an oral&#44; selective prostacyclin receptor agonist for the treatment of pulmonary arterial hypertension"
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                          "etal" => true
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                            2 => "M&#46;M&#46; Hoeper"
                            3 => "M&#46; Delcroix"
                            4 => "K&#46; Karlocai"
                            5 => "N&#46; Galie"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur Respir J"
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                        "paginaInicial" => "874"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22362844"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of beraprost sodium&#44; an oral prostacyclin analogue&#44; in patients with pulmonary arterial hypertension&#58; a randomized&#44; double-blind&#44; placebo-controlled trial"
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                        0 => array:2 [
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                            2 => "J&#46;-L&#46; Vachiery"
                            3 => "C&#46;D&#46; Vizza"
                            4 => "M&#46; Kneussl"
                            5 => "A&#46; Manes"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
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                        "paginaFinal" => "1502"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11985913"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0330"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pulmonary hypertension in Portugal&#58; first data from a nationwide registry"
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                            4 => "A&#46;M&#46; da Silva"
                            5 => "T&#46; Shiang"
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Biomed Res Int"
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                        "paginaInicial" => "489574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24228252"
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                      "titulo" => "Real-world&#44; long-term survival of incident patients with pulmonary arterial hypertension"
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                        "tituloSerie" => "Rev Port Pneumol"
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                        "volumen" => "23"
                        "paginaInicial" => "124"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Guidelines for the management of pulmonary hypertension patients"
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                            5 => "A&#46;N&#46; Diogo"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "paginaInicial" => "253"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20545252"
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                    0 => array:2 [
                      "titulo" => "Pulmonary arterial hypertension &#8211; experience of Centro Hospitalar de Vila Nova de Gaia"
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                            4 => "P&#46; Ferreira"
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                  "host" => array:1 [
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                        "paginaInicial" => "239"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17492235"
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                            3 => "X&#46; Jiang"
                            4 => "D&#46;P&#46; Miller"
                            5 => "A&#46;J&#46; Peacock"
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                    0 => array:2 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24286633"
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                    0 => array:2 [
                      "titulo" => "An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry"
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                        "paginaInicial" => "448"
                        "paginaFinal" => "456"
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                          0 => array:2 [
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                        "volumen" => "168"
                        "paginaInicial" => "871"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension"
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                        "paginaInicial" => "549"
                        "paginaFinal" => "555"
                        "link" => array:1 [
                          0 => array:2 [
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                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "ASPIRE registry&#58; Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre"
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                        0 => array:2 [
                          "etal" => true
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                            4 => "C&#46; Hill"
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                    0 => array:2 [
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                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Registry and survival study in Chinese patients with idiopathic and familial pulmonary arterial hypertension"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46;-C&#46; Jing"
                            1 => "X&#46;-Q&#46; Xu"
                            2 => "Z&#46;-Y&#46; Han"
                            3 => "Y&#46; Wu"
                            4 => "K&#46;-W&#46; Deng"
                            5 => "H&#46; Wang"
                          ]
                        ]
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                        "volumen" => "132"
                        "paginaInicial" => "373"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17400671"
                            "web" => "Medline"
                          ]
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                ]
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                    0 => array:2 [
                      "titulo" => "Changing demographics&#44; epidemiology&#44; and survival of incident pulmonary arterial hypertension&#58; results from the pulmonary hypertension registry of the United Kingdom and Ireland"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "D&#46;G&#46; Kiely"
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                            4 => "C&#46;A&#46; Elliot"
                            5 => "J&#46;S&#46;R&#46; Gibbs"
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                        "fecha" => "2012"
                        "volumen" => "186"
                        "paginaInicial" => "790"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22798320"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Clinical characteristics and survival of patients with pulmonary hypertension&#58; a 40-month mean follow-up"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Lopez Reyes"
                            1 => "D&#46; Nauffal Manzur"
                            2 => "A&#46; Garcia Ortega"
                            3 => "M&#46;A&#46; Menendez Salinas"
                            4 => "E&#46; Ansotegui Barrera"
                            5 => "B&#46; Balerdi Perez"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1111/crj.12312"
                      "Revista" => array:2 [
                        "tituloSerie" => "Clin Respir J"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "Long-term data from the Swiss pulmonary hypertension registry"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mueller-Mottet"
                            1 => "H&#46; Stricker"
                            2 => "G&#46; Domeninghetti"
                            3 => "A&#46; Azzola"
                            4 => "T&#46; Geiser"
                            5 => "M&#46; Schwerzmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000370125"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2015"
                        "volumen" => "89"
                        "paginaInicial" => "127"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25661477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "35"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in pulmonary arterial hypertension&#58; a reappraisal of the NIH risk stratification equation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Thenappan"
                            1 => "S&#46;J&#46; Shah"
                            2 => "S&#46; Rich"
                            3 => "L&#46; Tian"
                            4 => "S&#46;L&#46; Archer"
                            5 => "M&#46; Gomberg-Maitland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00072709"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1087"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20032020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary arterial hypertension in France&#58; results from a national registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Humbert"
                            1 => "O&#46; Sitbon"
                            2 => "A&#46; Chaouat"
                            3 => "M&#46; Bertocchi"
                            4 => "G&#46; Habib"
                            5 => "V&#46; Gressin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200510-1668OC"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "173"
                        "paginaInicial" => "1023"
                        "paginaFinal" => "1030"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16456139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension&#58; a 1-year follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Hughes"
                            1 => "X&#46; Jais"
                            2 => "D&#46; Bonderman"
                            3 => "J&#46; Suntharalingam"
                            4 => "M&#46; Humbert"
                            5 => "I&#46; Lang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00135905"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "138"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16611652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Condliffe"
                            1 => "D&#46;G&#46; Kiely"
                            2 => "J&#46;S&#46;R&#46; Gibbs"
                            3 => "P&#46;A&#46; Corris"
                            4 => "A&#46;J&#46; Peacock"
                            5 => "D&#46;P&#46; Jenkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200712-1841OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "177"
                        "paginaInicial" => "1122"
                        "paginaFinal" => "1127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18292468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management and outcomes in chronic thromboembolic pulmonary hypertension&#58; from expert centers to a nationwide perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Escribano-Subias"
                            1 => "R&#46; Del Pozo"
                            2 => "A&#46; Roman-Broto"
                            3 => "J&#46;A&#46; Domingo Morera"
                            4 => "A&#46; Lara-Padron"
                            5 => "T&#46; Elias Hernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.11.039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "203"
                        "paginaInicial" => "938"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26618257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "40"
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                0 => array:3 [
                  "comentario" => "doi&#58;2008&#47;25&#47;smw-11914"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary hypertension in Switzerland&#58; treatment and clinical course"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Fischler"
                            1 => "R&#46; Speich"
                            2 => "L&#46; Dorschner"
                            3 => "L&#46; Nicod"
                            4 => "G&#46; Domenighetti"
                            5 => "M&#46; Tamm"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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                        "tituloSerie" => "Swiss Med Wkly"
                        "fecha" => "2008"
                        "volumen" => "138"
                        "paginaInicial" => "371"
                        "paginaFinal" => "378"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18587689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in patients with primary pulmonary hypertension&#58; results from a national prospective registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;E&#46; D&#8217;Alonzo"
                            1 => "R&#46;J&#46; Barst"
                            2 => "S&#46;M&#46; Ayres"
                            3 => "E&#46;H&#46; Bergofsky"
                            4 => "B&#46;H&#46; Brundage"
                            5 => "K&#46;M&#46; Detre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1991"
                        "volumen" => "115"
                        "paginaInicial" => "343"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1863023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival of Chinese patients with pulmonary arterial hypertension in the modern treatment era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Zhang"
                            1 => "L&#46;-Z&#46; Dai"
                            2 => "W&#46;-P&#46; Xie"
                            3 => "Z&#46;-X&#46; Yu"
                            4 => "B&#46;-X&#46; Wu"
                            5 => "L&#46; Pan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-2327"
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                        "tituloSerie" => "Chest"
                        "fecha" => "2011"
                        "volumen" => "140"
                        "paginaInicial" => "301"
                        "paginaFinal" => "309"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21330386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0440"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary arterial hypertension and its prognosis in the modern management era in developed and developing countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Jiang"
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                            2 => "Z&#46;-C&#46; Jing"
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                        "fecha" => "2012"
                        "paginaInicial" => "85"
                        "paginaFinal" => "93"
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                    ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Survival in an incident cohort of patients with pulmonary arterial hypertension in Denmark"
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                            0 => "K&#46; Korsholm"
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                        "paginaInicial" => "364"
                        "paginaFinal" => "369"
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                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension"
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                        "paginaInicial" => "834"
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                        "link" => array:1 [
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Article information

ISSN: 25310437
Original language: English

DOI:10.1016/j.pulmoe.2018.02.003

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Year/Month	Html	Pdf	Total

2024 November	9	5	14
2024 October	30	31	61
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2024 August	58	54	112
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2023 October	49	53	102
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2020 February	44	20	64
2020 January	42	22	64
2019 December	46	25	71
2019 November	46	22	68
2019 October	46	17	63
2019 September	46	25	71
2019 August	142	22	164
2019 July	126	28	154
2019 June	122	16	138
2019 May	135	27	162
2019 April	118	45	163
2019 March	119	21	140
2019 February	95	20	115
2019 January	103	41	144
2018 December	42	10	52
2018 November	4	0	4
2018 October	1	0	1

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