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with a median survival of 50&#37; at 12 months of diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The definitive diagnosis of PHT is made with right heart catheterization&#59; however&#44; there are another 4 screening measurements used in most studies due to good correlation with the hemodynamic values obtained with cardiac catheterization&#58; first&#44; the measurement of pulmonary artery systolic pressure &#40;sPAP&#41;&#59; second&#44; the speed of the tricuspid reflux &#40;VRT&#41;&#44; both parameters measured by transthoracic Doppler&#59; third&#44; considered as a predictor&#44; the decrease of the diffusion coefficient of carbon monoxide &#40;DLCO&#41; calculated by means of the RFT&#44; and finally the elevation in serum N-terminal brain natriuretic peptide &#40;N-terminal BNP&#41; prohormone&#44; recently reviewed&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this paper&#44; we studied a population with SS and PHT with clinical&#44; immunologic&#44; echocardiographic and spirometry parameters&#44; and tried to identify predictors of higher levels of sPAP&#46; We also studied the influence of PHT in the prognosis of these patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study included 331 patients with a diagnosis of SS controlled at the Systemic Autoimmune Diseases Unit of the Internal Medicine department&#44; University Hospital Vall d&#8217;Hebron&#44; until 2009&#46; Of these patients&#44; we studied 68 patients who met PHT criteria by duplex Doppler considering PHT sPAP values above 35<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We divided the population according to clinical characteristics in subtypes of SS &#40;limited&#44; diffuse and no SS&#41;&#46; These patients underwent spirometry with DLCO and FVC measurements&#44; a computed tomography &#40;CT&#41;&#44; an immunological profile and capillaroscopy following a study protocol used in the department&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Two patterns were considered for capillaroscopy&#58; slow&#44; characterized by the presence of megacapillaries&#44; no hair loss&#44; and a current pattern for important<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> hair loss&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS 11&#46;5 for Windows&#46; The association between variables was performed using the Pearson correlation coefficient and results were considered statistically significant if presenting <span class="elsevierStyleItalic">P</span> values of less than &#46;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">331 patients with SS were included in the study&#44; of which 68 &#40;20&#46;5&#37;&#41; had sPAP&#62;35<span class="elsevierStyleHsp" style=""></span>mmHg&#46; The mean age of patients was 56&#46;3&#177;14&#46;4 years&#41;&#44; 61 were women &#40;90&#37;&#41; and 7 men &#40;10&#37;&#41;&#44; with a 9&#58;1 ratio&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Raynaud&#39;s phenomenon was the first most common manifestation of SS in all subtypes studied&#46; The average time from the first manifestation of the disease until the diagnosis of the same was 9&#46;5&#177;11 years&#46; Clinical and immunological characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The average sPAP by ECHO at rest was 54&#46;9&#177;18<span class="elsevierStyleHsp" style=""></span>mmHg&#44; while the mean VRT was 3&#46;3<span class="elsevierStyleHsp" style=""></span>m&#47;s&#46; With respect to respiratory function tests&#44; we found a mean DLCO of 45&#46;7&#37;&#177;34&#37; predicted&#44; a FVC of 59&#46;5&#37;&#43;27&#46;8&#37; predicted&#44; and ratio of the FVC&#47;DLCO of 1&#46;3&#177;0&#46;6&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Using chest CT we found interstitial disease in 52&#37; &#40;30&#47;58&#41; of patients&#44; and 28&#37; &#40;16&#47;58&#41; of patients had a limited form&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated the Pearson correlation coefficient with the following variables FVC-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;040&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;373&#41;&#44; FVC&#47;DLCO-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;150&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;149&#41;&#44; DLCO-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;282&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;01&#41; and VRT-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;658&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;0001&#41;&#44; demonstrating a linear association of moderate significance in relation to these 2 last variables &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We also analyzed other variables such as the presence of distal ulcers &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;184&#41;&#44; the active capillaroscopy pattern &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;241&#41;&#44; the presence of antibodies to ACA &#40;0&#46;351&#41; or Scl70 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;330&#41;&#44; interstitial pulmonary involvement diagnosed by CT &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;073&#41; and its relationship to the severity of the PHT&#44; although no statistically significant association with any of these variables was found&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">There were 29 deaths &#40;42&#46;6&#37;&#41;&#44; of which PHT was the fundamental cause in 12 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The years from diagnosis to death due to PHT were 1&#46;8 years&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study we observed a prevalence of PHT assessed by Doppler ultrasound of 20&#46;5&#37; and a correlation between increased values of pulmonary artery systolic pressure and decreased DLCO values with increasing VRT values statistically significant&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The prevalence found is similar to that described in other series&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Thus&#44; the study of Vonk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> of the POEMS database found a prevalence of 9&#46;9&#37;&#59; in the Launay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> study it was 18&#46;3&#37; and in the UNCOVER study the prevalence was 26&#46;7&#37;&#46; Probably&#44; this variation is due to different diagnostic methods &#40;Doppler and right heart catheterization&#41;&#44; the different characteristics of the populations studied and the criteria used to define PHT&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">By analyzing the values of PHT and DLCO levels&#44; we observed that a decrease of 50&#37; predicted higher numbers of pulmonary artery pressure&#46; This is similar to that found by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Mathai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> found that the decrease in DLCO correlated PHBP in patients with interstitial lung disease&#44; with the decrease in DLCO a marker of increased pulmonary pressure numbers&#46; In the Itin&#233;rAIR-Scl&#233;rodermie<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> study&#44; it has been observed that a DLCO less than 60&#37; predicted normal lung volumes associated with the echocardiographic diagnosis of PHT and that this decline may precede by several years the appearance of PHT&#46; These data suggest that the decline in the numbers of DLCO is a predictor of the development of PHT&#44; even in asymptomatic patients&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Other parameters to consider are VRT and sPAP&#46; European guidelines for the diagnosis of PHT<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have been established arbitrarily to estimate the presence of VRT due to PHT and sPAP estimated by ECHO&#46; Thus a VRT between 2&#46;9 and 3&#46;4<span class="elsevierStyleHsp" style=""></span>m&#47;s and sPAP between 37 and 50<span class="elsevierStyleHsp" style=""></span>mmHg can be used as criteria to define a possible PHT&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Currently&#44; PHT is the leading cause of mortality in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Prior to the use of ACE inhibitors&#44; renal crisis were the largest cause of mortality in patients with SS&#44; but since the advent of these drugs&#44; there has been a decrease in the number of newly affected renal patients&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">This study found a mortality of 42&#46;6&#37; among patients diagnosed with PHT and SS&#44; with PHT itself the most common cause of death&#44; followed by pulmonary fibrosis&#46; These data are consistent with the Iten&#233;rAIR-Scl&#233;rodermie study&#44; which showed a cumulative mortality of 3&#46;04 per 100 patients&#47;year with SS&#44; with PHT the cause of death in 32&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The time elapsed from diagnosis of PHT and death found in this study was 1&#46;8 years&#44; similar to that found in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> MacGregor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported that an sPAP measured by Doppler greater than or equal to 30<span class="elsevierStyleHsp" style=""></span>mmHg was associated with increased mortality of 20&#37;&#46; Mukerjee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> found that patients with sPAP&#62;45<span class="elsevierStyleHsp" style=""></span>mmHg had a mortality 30&#37; higher at one year than patients with sPAP&#60;32<span class="elsevierStyleHsp" style=""></span>mmHg and that survival was 81&#44; 63 and 56&#37; at 1&#44; 2&#44; and 3 years&#44; respectively&#44; after the diagnosis of PHT&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The influence of PHT in the survival of these patients is especially important considering that&#44; initially&#44; PHT goes unnoticed and the first symptoms are often attributed generally to the underlying disease&#44; delaying diagnosis and treatment&#46; The detection of this complication in the early stages is therefore recommended&#44; when treatment could prevent or halt its progression&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Thus sPAP and the VRT measured by Doppler echocardiograph&#44; and DLCO values measured by spirometry&#44; being non-lethal methods&#44; are easily accessible&#44; and may be useful as screening methods for PHT&#46; However&#44; it is important to note that the final confirmation of the diagnosis of this complication continues to be the performance of right cardiac catheterization&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;7&#44;12</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In this paper the detection of sPAP was made by echo-Doppler and not by right heart catheterization&#44; which is a major limiting factor&#46; However&#44; major works&#44; as exemplified by the EUSTAR<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> group&#44; on the causes of death and associated risk factors in patients with SS&#44; used the Doppler method for the diagnosis of PHT&#46; Another limiting factor that we must note is that this is a retrospective study and we did not study brain natriuretic peptide&#44; which is currently used as a predictor of PHT&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In short&#44; the PHT worsens the prognosis of patients with SS in the very short term&#46; Therefore it is important to find predictors of onset&#44; as early detection and treatment would help avoid much of both progression and the complications that this entails&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects</span>&#46; The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data</span>&#46; The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent</span>&#46; The authors have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2011-11-28"
    "fechaAceptado" => "2012-03-08"
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            0 => "Scleroderma"
            1 => "Pulmonary artery hypertension"
            2 => "Doppler echocardiography"
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          "clase" => "keyword"
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            0 => "Esclerodermia"
            1 => "Hipertensi&#243;n arterial pulmonar"
            2 => "Ecocardiograf&#237;a Doppler"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical&#8211;biological characteristics of patients with scleroderma &#40;SS&#41; and pulmonary artery hypertension &#40;PAH&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To establish the relationship between pulmonary functional tests &#40;PFT&#41;&#44; Doppler echocardiography &#40;ECHO&#41; and the severity of the PAH&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of patients with SS treated at a tertiary center&#46; All participants received a protocol study&#44; which included a complete analysis and additional tests&#58; ECHO and PFT with carbon monoxide diffusing capacity &#40;DLCO&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overall&#44; 331 patients were treated&#44; including 68 &#40;20&#46;5&#37;&#41; with PAH&#46; The limited subtype of SS was the most prevalent&#46; The Pearson&#39;s correlation coefficient was used for the following variables&#58; FVC-sPAP&#44; FVC&#47;DLCO-sPAP&#44; DLCO-sPAP and TRV-sPAP&#44; showed a significant moderate linear association in the relationship DLCO-sPAP and TRV-sPAP&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">29 deaths occurred&#44; with 12 of them related to PAH&#46; The median time between the PAH diagnosis and death was 1&#46;8 years&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The decrease in DLCO and the increase in TRV are negative predictor factor of PAH which&#44; at the same time&#44; means a worsening prognosis for patients with SS&#46;</p>"
      ]
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nico-biol&#243;gicas de pacientes con esclerodermia &#40;ES&#41; e hipertensi&#243;n arterial pulmonar &#40;HTAP&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Establecer la relaci&#243;n entre las pruebas funcionales respiratorias &#40;PFR&#41;&#44; la ecocardiograf&#237;a Doppler &#40;eco-Doppler&#41; y la gravedad de la HTAP&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes con diagn&#243;stico de ES seguidos en un centro de tercer nivel&#46; Se les realiz&#243; un estudio protocolizado con anal&#237;tica completa y pruebas complementarias&#59; se estim&#243; la presi&#243;n arterial pulmonar sist&#243;lica &#40;PAPs&#41;&#44; la velocidad de reflujo de la v&#225;lvula tric&#250;spide &#40;VRT&#41;&#44; la difusi&#243;n de mon&#243;xido de carbono &#40;DLCO&#41; y la capacidad vital forzada &#40;CVF&#41;&#44; por medio de la eco-Doppler y la PFR&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 331 pacientes&#44; de los cuales 68 &#40;20&#44;5&#37;&#41; ten&#237;an HTAP&#46; El subtipo de ES m&#225;s prevalente fue la limitada&#46; Se calcul&#243; el coeficiente de correlaci&#243;n de Pearson a las siguientes variables&#58; CVF-PAPs CVF&#47;DLCO-PAPs&#44; DLCO-PAP y VRT-PAPs&#44; observ&#225;ndose una asociaci&#243;n lineal moderada significativa en la relaci&#243;n DLCO-PAPs y con VRT-PAP&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se constataron 29 fallecimientos&#44; 12 relacionados a la HTAP&#46; El tiempo medio entre el diagn&#243;stico de HTAP y la muerte fue de 1&#44;8 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La disminuci&#243;n de la DLCO y el aumento de la VRT son factores predictores de HTAP&#44; que al mismo tiempo condiciona un peor pron&#243;stico en los pacientes con ES&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Acosta Colm&#225;n MI&#44; et al&#46; &#191;Podemos predecir la gravedad de la hipertensi&#243;n arterial pulmonar en pacientes con esclerodermia&#63; Reumatol Clin&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.03.007">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;reuma&#46;2012&#46;03&#46;007</span>&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between sPAP and DLCO &#40;n&#61;49&#41;&#46; <span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;282&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;01&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Limited&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No Scleroderma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Number of patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;68 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#47;68 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;68 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Clinical characteristics</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Raynaud&#39;s phenomenon</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;16 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#47;41 &#40;92&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;11 &#40;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Capillaroscopy pattern</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Slow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;16 &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;41 &#40;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;11 &#40;81&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;16 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;41 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Undefined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;16 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;11 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presence of ulcers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;16 &#40;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#47;41 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;11 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Immunological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>ACA &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;16 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#47;38 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;10 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Scl70 &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;16 &#40;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;38 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;11 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">RFT</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>DLCO &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#37; &#40;n&#61;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;n&#61;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#37; &#40;n&#61;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>CVF &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37; &#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#37; &#40;n&#61;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#37; &#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TAC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Interstitial affection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;16 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;10 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No interstitial affection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;16 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;10 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">echo-Doppler</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean sPAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;n&#61;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;n&#61;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean VRT &#40;m&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;38 &#40;n&#61;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;33 &#40;n&#61;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;24 &#40;n&#61;9&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; Immunological and Complementary Test Characteristics in Patients With SS and PTH&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Patients&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PHT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;29 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PHT&#43;pulmonary fibrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#47;29 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;29 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#47;29 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;29 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Disseminated neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;29 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
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                  "host" => array:1 [
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                            1 => "B&#46; Bannert"
                            2 => "M&#46; Vonk"
                            3 => "P&#46; Air&#242;"
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                  "host" => array:1 [
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Original Article
Can We Predict the Severity of Pulmonary Hypertension in Patients With Scleroderma?
¿Podemos predecir la gravedad de la hipertensión arterial pulmonar en pacientes con esclerodermia?
María Isabel Acosta Colmána,
Corresponding author
dr.acostacolman@gmail.com

Corresponding author.
, Gabriela Avila Pedrettia, María Eugenia Acostaa,b, Carmen Pilar Simeón Aznarb, Vicent Fonollosa Pláb, Miquel Villardel Torrésb
a Unidad de Reumatología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Unidad de Enfermedades Autoinmunes Sistémicas - Servicio de Medicina Interna, Hospital Universitario Vall d’Hebron, Barcelona, Spain
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between sPAP and DLCO &#40;n&#61;49&#41;&#46; <span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;282&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;01&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary involvement in patients with SS is considered&#44; after gastrointestinal complications&#44; a frequent visceral complication&#44; with a prevalence of approximately 80&#37;&#46; This complication may be due to diffuse involvement of the pulmonary interstitium or the appearance of pulmonary hypertension &#40;PHT&#41;&#46; The latter with a prevalence estimated at 12&#37;&#8211;26&#37; depending on diagnostic criteria&#44; from scanning and population estudiada&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">PHT is generally considered a late complication of SS&#46; Previous studies found that the TIME between the diagnosis of SS and the beginning of the PHT is between 9&#46;08&#177;6&#46;6<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and 14&#177;5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is also a major cause of morbidity and mortality in patients&#44; with a median survival of 50&#37; at 12 months of diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The definitive diagnosis of PHT is made with right heart catheterization&#59; however&#44; there are another 4 screening measurements used in most studies due to good correlation with the hemodynamic values obtained with cardiac catheterization&#58; first&#44; the measurement of pulmonary artery systolic pressure &#40;sPAP&#41;&#59; second&#44; the speed of the tricuspid reflux &#40;VRT&#41;&#44; both parameters measured by transthoracic Doppler&#59; third&#44; considered as a predictor&#44; the decrease of the diffusion coefficient of carbon monoxide &#40;DLCO&#41; calculated by means of the RFT&#44; and finally the elevation in serum N-terminal brain natriuretic peptide &#40;N-terminal BNP&#41; prohormone&#44; recently reviewed&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this paper&#44; we studied a population with SS and PHT with clinical&#44; immunologic&#44; echocardiographic and spirometry parameters&#44; and tried to identify predictors of higher levels of sPAP&#46; We also studied the influence of PHT in the prognosis of these patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study included 331 patients with a diagnosis of SS controlled at the Systemic Autoimmune Diseases Unit of the Internal Medicine department&#44; University Hospital Vall d&#8217;Hebron&#44; until 2009&#46; Of these patients&#44; we studied 68 patients who met PHT criteria by duplex Doppler considering PHT sPAP values above 35<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We divided the population according to clinical characteristics in subtypes of SS &#40;limited&#44; diffuse and no SS&#41;&#46; These patients underwent spirometry with DLCO and FVC measurements&#44; a computed tomography &#40;CT&#41;&#44; an immunological profile and capillaroscopy following a study protocol used in the department&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Two patterns were considered for capillaroscopy&#58; slow&#44; characterized by the presence of megacapillaries&#44; no hair loss&#44; and a current pattern for important<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> hair loss&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS 11&#46;5 for Windows&#46; The association between variables was performed using the Pearson correlation coefficient and results were considered statistically significant if presenting <span class="elsevierStyleItalic">P</span> values of less than &#46;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">331 patients with SS were included in the study&#44; of which 68 &#40;20&#46;5&#37;&#41; had sPAP&#62;35<span class="elsevierStyleHsp" style=""></span>mmHg&#46; The mean age of patients was 56&#46;3&#177;14&#46;4 years&#41;&#44; 61 were women &#40;90&#37;&#41; and 7 men &#40;10&#37;&#41;&#44; with a 9&#58;1 ratio&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Raynaud&#39;s phenomenon was the first most common manifestation of SS in all subtypes studied&#46; The average time from the first manifestation of the disease until the diagnosis of the same was 9&#46;5&#177;11 years&#46; Clinical and immunological characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The average sPAP by ECHO at rest was 54&#46;9&#177;18<span class="elsevierStyleHsp" style=""></span>mmHg&#44; while the mean VRT was 3&#46;3<span class="elsevierStyleHsp" style=""></span>m&#47;s&#46; With respect to respiratory function tests&#44; we found a mean DLCO of 45&#46;7&#37;&#177;34&#37; predicted&#44; a FVC of 59&#46;5&#37;&#43;27&#46;8&#37; predicted&#44; and ratio of the FVC&#47;DLCO of 1&#46;3&#177;0&#46;6&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Using chest CT we found interstitial disease in 52&#37; &#40;30&#47;58&#41; of patients&#44; and 28&#37; &#40;16&#47;58&#41; of patients had a limited form&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated the Pearson correlation coefficient with the following variables FVC-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;040&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;373&#41;&#44; FVC&#47;DLCO-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;150&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;149&#41;&#44; DLCO-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;282&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;01&#41; and VRT-sPAP &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;658&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;0001&#41;&#44; demonstrating a linear association of moderate significance in relation to these 2 last variables &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We also analyzed other variables such as the presence of distal ulcers &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;184&#41;&#44; the active capillaroscopy pattern &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;241&#41;&#44; the presence of antibodies to ACA &#40;0&#46;351&#41; or Scl70 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;330&#41;&#44; interstitial pulmonary involvement diagnosed by CT &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;073&#41; and its relationship to the severity of the PHT&#44; although no statistically significant association with any of these variables was found&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">There were 29 deaths &#40;42&#46;6&#37;&#41;&#44; of which PHT was the fundamental cause in 12 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The years from diagnosis to death due to PHT were 1&#46;8 years&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study we observed a prevalence of PHT assessed by Doppler ultrasound of 20&#46;5&#37; and a correlation between increased values of pulmonary artery systolic pressure and decreased DLCO values with increasing VRT values statistically significant&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The prevalence found is similar to that described in other series&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Thus&#44; the study of Vonk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> of the POEMS database found a prevalence of 9&#46;9&#37;&#59; in the Launay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> study it was 18&#46;3&#37; and in the UNCOVER study the prevalence was 26&#46;7&#37;&#46; Probably&#44; this variation is due to different diagnostic methods &#40;Doppler and right heart catheterization&#41;&#44; the different characteristics of the populations studied and the criteria used to define PHT&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">By analyzing the values of PHT and DLCO levels&#44; we observed that a decrease of 50&#37; predicted higher numbers of pulmonary artery pressure&#46; This is similar to that found by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Mathai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> found that the decrease in DLCO correlated PHBP in patients with interstitial lung disease&#44; with the decrease in DLCO a marker of increased pulmonary pressure numbers&#46; In the Itin&#233;rAIR-Scl&#233;rodermie<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> study&#44; it has been observed that a DLCO less than 60&#37; predicted normal lung volumes associated with the echocardiographic diagnosis of PHT and that this decline may precede by several years the appearance of PHT&#46; These data suggest that the decline in the numbers of DLCO is a predictor of the development of PHT&#44; even in asymptomatic patients&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Other parameters to consider are VRT and sPAP&#46; European guidelines for the diagnosis of PHT<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have been established arbitrarily to estimate the presence of VRT due to PHT and sPAP estimated by ECHO&#46; Thus a VRT between 2&#46;9 and 3&#46;4<span class="elsevierStyleHsp" style=""></span>m&#47;s and sPAP between 37 and 50<span class="elsevierStyleHsp" style=""></span>mmHg can be used as criteria to define a possible PHT&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Currently&#44; PHT is the leading cause of mortality in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Prior to the use of ACE inhibitors&#44; renal crisis were the largest cause of mortality in patients with SS&#44; but since the advent of these drugs&#44; there has been a decrease in the number of newly affected renal patients&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">This study found a mortality of 42&#46;6&#37; among patients diagnosed with PHT and SS&#44; with PHT itself the most common cause of death&#44; followed by pulmonary fibrosis&#46; These data are consistent with the Iten&#233;rAIR-Scl&#233;rodermie study&#44; which showed a cumulative mortality of 3&#46;04 per 100 patients&#47;year with SS&#44; with PHT the cause of death in 32&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The time elapsed from diagnosis of PHT and death found in this study was 1&#46;8 years&#44; similar to that found in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> MacGregor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported that an sPAP measured by Doppler greater than or equal to 30<span class="elsevierStyleHsp" style=""></span>mmHg was associated with increased mortality of 20&#37;&#46; Mukerjee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> found that patients with sPAP&#62;45<span class="elsevierStyleHsp" style=""></span>mmHg had a mortality 30&#37; higher at one year than patients with sPAP&#60;32<span class="elsevierStyleHsp" style=""></span>mmHg and that survival was 81&#44; 63 and 56&#37; at 1&#44; 2&#44; and 3 years&#44; respectively&#44; after the diagnosis of PHT&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The influence of PHT in the survival of these patients is especially important considering that&#44; initially&#44; PHT goes unnoticed and the first symptoms are often attributed generally to the underlying disease&#44; delaying diagnosis and treatment&#46; The detection of this complication in the early stages is therefore recommended&#44; when treatment could prevent or halt its progression&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Thus sPAP and the VRT measured by Doppler echocardiograph&#44; and DLCO values measured by spirometry&#44; being non-lethal methods&#44; are easily accessible&#44; and may be useful as screening methods for PHT&#46; However&#44; it is important to note that the final confirmation of the diagnosis of this complication continues to be the performance of right cardiac catheterization&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;7&#44;12</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In this paper the detection of sPAP was made by echo-Doppler and not by right heart catheterization&#44; which is a major limiting factor&#46; However&#44; major works&#44; as exemplified by the EUSTAR<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> group&#44; on the causes of death and associated risk factors in patients with SS&#44; used the Doppler method for the diagnosis of PHT&#46; Another limiting factor that we must note is that this is a retrospective study and we did not study brain natriuretic peptide&#44; which is currently used as a predictor of PHT&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In short&#44; the PHT worsens the prognosis of patients with SS in the very short term&#46; Therefore it is important to find predictors of onset&#44; as early detection and treatment would help avoid much of both progression and the complications that this entails&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects</span>&#46; The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data</span>&#46; The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent</span>&#46; The authors have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical&#8211;biological characteristics of patients with scleroderma &#40;SS&#41; and pulmonary artery hypertension &#40;PAH&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To establish the relationship between pulmonary functional tests &#40;PFT&#41;&#44; Doppler echocardiography &#40;ECHO&#41; and the severity of the PAH&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of patients with SS treated at a tertiary center&#46; All participants received a protocol study&#44; which included a complete analysis and additional tests&#58; ECHO and PFT with carbon monoxide diffusing capacity &#40;DLCO&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overall&#44; 331 patients were treated&#44; including 68 &#40;20&#46;5&#37;&#41; with PAH&#46; The limited subtype of SS was the most prevalent&#46; The Pearson&#39;s correlation coefficient was used for the following variables&#58; FVC-sPAP&#44; FVC&#47;DLCO-sPAP&#44; DLCO-sPAP and TRV-sPAP&#44; showed a significant moderate linear association in the relationship DLCO-sPAP and TRV-sPAP&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">29 deaths occurred&#44; with 12 of them related to PAH&#46; The median time between the PAH diagnosis and death was 1&#46;8 years&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The decrease in DLCO and the increase in TRV are negative predictor factor of PAH which&#44; at the same time&#44; means a worsening prognosis for patients with SS&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nico-biol&#243;gicas de pacientes con esclerodermia &#40;ES&#41; e hipertensi&#243;n arterial pulmonar &#40;HTAP&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Establecer la relaci&#243;n entre las pruebas funcionales respiratorias &#40;PFR&#41;&#44; la ecocardiograf&#237;a Doppler &#40;eco-Doppler&#41; y la gravedad de la HTAP&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes con diagn&#243;stico de ES seguidos en un centro de tercer nivel&#46; Se les realiz&#243; un estudio protocolizado con anal&#237;tica completa y pruebas complementarias&#59; se estim&#243; la presi&#243;n arterial pulmonar sist&#243;lica &#40;PAPs&#41;&#44; la velocidad de reflujo de la v&#225;lvula tric&#250;spide &#40;VRT&#41;&#44; la difusi&#243;n de mon&#243;xido de carbono &#40;DLCO&#41; y la capacidad vital forzada &#40;CVF&#41;&#44; por medio de la eco-Doppler y la PFR&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 331 pacientes&#44; de los cuales 68 &#40;20&#44;5&#37;&#41; ten&#237;an HTAP&#46; El subtipo de ES m&#225;s prevalente fue la limitada&#46; Se calcul&#243; el coeficiente de correlaci&#243;n de Pearson a las siguientes variables&#58; CVF-PAPs CVF&#47;DLCO-PAPs&#44; DLCO-PAP y VRT-PAPs&#44; observ&#225;ndose una asociaci&#243;n lineal moderada significativa en la relaci&#243;n DLCO-PAPs y con VRT-PAP&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se constataron 29 fallecimientos&#44; 12 relacionados a la HTAP&#46; El tiempo medio entre el diagn&#243;stico de HTAP y la muerte fue de 1&#44;8 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La disminuci&#243;n de la DLCO y el aumento de la VRT son factores predictores de HTAP&#44; que al mismo tiempo condiciona un peor pron&#243;stico en los pacientes con ES&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Acosta Colm&#225;n MI&#44; et al&#46; &#191;Podemos predecir la gravedad de la hipertensi&#243;n arterial pulmonar en pacientes con esclerodermia&#63; Reumatol Clin&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.03.007">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;reuma&#46;2012&#46;03&#46;007</span>&#46;</p>"
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between sPAP and DLCO &#40;n&#61;49&#41;&#46; <span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;282&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;01&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlation between sPAP and VRT &#40;n&#61;48&#41;&#46; <span class="elsevierStyleItalic">r</span>&#61;0&#46;658&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;0001&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">RFT&#58; respiratory function tests&#59; DLCO&#58; carbon monoxide diffusion&#59; CVF&#58; forced vital capacity&#59; PAP&#58; pulmonary arterial pressure&#59; ACA&#58; anticentromere antibodies&#59; Scl70&#58; anti sclera 70 antibodies&#59; echo-Doppler&#58; Doppler echocardiography&#59; sPAP&#58; systolic pulmonary arterial pressure&#59; VRT&#58; tricuspid valve reflux speed&#59; n&#58; number of patients with available test results&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Immunological</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;16 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#47;38 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">RFT</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>DLCO &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#37; &#40;n&#61;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;n&#61;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#37; &#40;n&#61;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>CVF &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#37; &#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63&#37; &#40;n&#61;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#37; &#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TAC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Interstitial affection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#47;16 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#47;32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;10 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No interstitial affection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;16 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;10 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">echo-Doppler</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean sPAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;n&#61;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;n&#61;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean VRT &#40;m&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;38 &#40;n&#61;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;33 &#40;n&#61;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;24 &#40;n&#61;9&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; Immunological and Complementary Test Characteristics in Patients With SS and PTH&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">PHT&#44; pulmonary arterial hypertension&#59; SS&#44; scleroderma&#46;</p>"
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                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Patients&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;29 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PHT&#43;pulmonary fibrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#47;29 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Pulmonary fibrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;29 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PHT&#43;renal crisis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;29 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Heart failure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;29 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Disseminated neoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;29 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;29 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Renal crisis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;29 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Causes of Death in Patients With SS and PHT&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bibs0005"
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                    0 => array:2 [
                      "titulo" => "Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension&#58; application of a registry approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Mukerjee"
                            1 => "D&#46; St George"
                            2 => "B&#46; Coleiro"
                            3 => "C&#46; Knight"
                            4 => "C&#46;P&#46; Denton"
                            5 => "J&#46; Davar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2003"
                        "volumen" => "62"
                        "paginaInicial" => "1088"
                        "paginaFinal" => "1093"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14583573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of undiagnosed pulmonary arterial hypertension in subjects with connective tissue disease at the secondary health care level of community-based rheumatologist &#40;the UNCOVER study&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Wigley"
                            1 => "J&#46; Lima"
                            2 => "M&#46; Mayes"
                            3 => "D&#46; McLain"
                            4 => "J&#46; Chapin"
                            5 => "C&#46; Ward-Able"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.21131"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "2125"
                        "paginaFinal" => "2132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15986394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of exercise pulmonary arterial hypertension in scleroderma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Callejas"
                            1 => "E&#46; Moreno"
                            2 => "P&#46; Mart&#237;n"
                            3 => "L&#46;L&#46; P&#233;rez"
                            4 => "R&#46;R&#46; Fern&#225;ndez"
                            5 => "D&#46; S&#225;nchez-Cano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk Factors associated with pulmonary arterial hypertension in Colombian patients with systemic sclerosis&#58; review of the literature"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Coral-Alvarado"
                            1 => "A&#46; Rojas-Villarraga"
                            2 => "M&#46;C&#46; Latorre"
                            3 => "R&#46;D&#46; Mantilla"
                            4 => "J&#46;F&#46; Restrepo"
                            5 => "A&#46;L&#46; Pardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "2"
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109799005409"
                          "estado" => "S300"
                          "issn" => "07351097"
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              "identificador" => "bib0025"
              "etiqueta" => "5"
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Idiomas
Reumatología Clínica (English Edition)
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