Statistics

 array:21 [
  "pii" => "X2013251412002115"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jul.11556"
  "estado" => "S300"
  "fechaPublicacion" => "2012-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:848-50"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6653
    "formatos" => array:3 [
      "EPUB" => 284
      "HTML" => 5749
      "PDF" => 620
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512002118"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jul.11556"
      "estado" => "S300"
      "fechaPublicacion" => "2012-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:848-50"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 14466
        "formatos" => array:3 [
          "EPUB" => 336
          "HTML" => 13395
          "PDF" => 735
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Debut de amiloidosis AL con afectación grave cardíaca y renal: una asociación poco frecuente de infausto pronóstico. A raíz de 2 casos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "848"
            "paginaFinal" => "850"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Amyloidosis AL with severe renal and cardiac involvement: a very rare association of terrible prognosis, two case reports"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11556_19759_31911_es_11556_t1.jpg"
                "Alto" => 847
                "Ancho" => 600
                "Tamanyo" => 428834
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Parámetros analíticos de los 2 casos al ingreso"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Maria Núñez-Torras, Nàdia Martín-Alemany, Martí Vallès-Prats, Xavier Albert-Bertran"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "Núñez-Torras"
              ]
              1 => array:2 [
                "nombre" => "Nàdia"
                "apellidos" => "Martín-Alemany"
              ]
              2 => array:2 [
                "nombre" => "Martí"
                "apellidos" => "Vallès-Prats"
              ]
              3 => array:2 [
                "nombre" => "Xavier"
                "apellidos" => "Albert-Bertran"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412002115"
          "doi" => "10.3265/Nefrologia.pre2012.Jul.11556"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002115?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002118?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002118/v0_201502091340/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412002107"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11468"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:850-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5846
      "formatos" => array:3 [
        "EPUB" => 277
        "HTML" => 4997
        "PDF" => 572
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Post-transplant Henoch-Schonlein purpura de novo: Clinical/histological discordance"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "850"
          "paginaFinal" => "852"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Púrpura de Henoch-Schonlein de novo postrasplante. Discordancia clínico-histológica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11468_108_39801_en_t111.jpg"
              "Alto" => 868
              "Ancho" => 1436
              "Tamanyo" => 251664
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Laboratory results and treatment provided"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Marcelo Nin, Rossana Cordero, Lidice Doufrechou, Alejandra Larre-Borges, Virginia Coria, Nelson Acosta, Liliana Gadola, Sergio Orihuela, Francisco González, Oscar Noboa"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Marcelo"
              "apellidos" => "Nin"
            ]
            1 => array:2 [
              "nombre" => "Rossana"
              "apellidos" => "Cordero"
            ]
            2 => array:2 [
              "nombre" => "Lidice"
              "apellidos" => "Doufrechou"
            ]
            3 => array:2 [
              "nombre" => "Alejandra"
              "apellidos" => "Larre-Borges"
            ]
            4 => array:2 [
              "nombre" => "Virginia"
              "apellidos" => "Coria"
            ]
            5 => array:2 [
              "nombre" => "Nelson"
              "apellidos" => "Acosta"
            ]
            6 => array:2 [
              "nombre" => "Liliana"
              "apellidos" => "Gadola"
            ]
            7 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Orihuela"
            ]
            8 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "González"
            ]
            9 => array:2 [
              "nombre" => "Oscar"
              "apellidos" => "Noboa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951200210X"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11468"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169951200210X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002107?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002107/v0_201502091603/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412002123"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jul.11488"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:846-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4803
      "formatos" => array:3 [
        "EPUB" => 301
        "HTML" => 3986
        "PDF" => 516
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "846"
          "paginaFinal" => "848"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Glomerulonefritis membranoproliferativa con depósito de IgG monoclonal en el mieloma múltiple"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11488_108_39789_en_f19.jpg"
              "Alto" => 488
              "Ancho" => 661
              "Tamanyo" => 134403
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Light microscope image. HE x10. Glomerulus with mesangial and endocapillary proliferation and thickening of capillary walls"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M. Dolores Redondo-Pachón, Ricardo Enríquez, Ana E. Sirvent, Encarna Andrada, Raimundo García-del Moral, Isabel Millán, Francisco Amorós"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "M. Dolores"
              "apellidos" => "Redondo-Pachón"
            ]
            1 => array:2 [
              "nombre" => "Ricardo"
              "apellidos" => "Enríquez"
            ]
            2 => array:2 [
              "nombre" => "Ana E."
              "apellidos" => "Sirvent"
            ]
            3 => array:2 [
              "nombre" => "Encarna"
              "apellidos" => "Andrada"
            ]
            4 => array:2 [
              "nombre" => "Raimundo"
              "apellidos" => "García-del Moral"
            ]
            5 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Millán"
            ]
            6 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Amorós"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002126"
        "doi" => "10.3265/Nefrologia.pre2012.Jul.11488"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002126?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002123?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002123/v0_201502091603/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Amyloidosis AL with severe renal and cardiac involvement: a very rare association of terrible prognosis, two case reports"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "848"
        "paginaFinal" => "850"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Maria Núñez-Torras, Nàdia Martín-Alemany, Martí Vallès-Prats, Xavier Albert-Bertran"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Núñez-Torras"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "N&#224;dia"
            "apellidos" => "Mart&#237;n-Alemany"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Mart&#237;"
            "apellidos" => "Vall&#232;s-Prats"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Xavier"
            "apellidos" => "Albert-Bertran"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitari Dr. Josep Trueta, Girona,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Debut de amiloidosis AL con afectaci&#243;n grave card&#237;aca y renal&#58; una asociaci&#243;n poco frecuente de infausto pron&#243;stico&#46; A ra&#237;z de 2 casos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11556_108_39794_en_t110.jpg"
            "Alto" => 1979
            "Ancho" => 1442
            "Tamanyo" => 511114
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Laboratory parameters of the two cases upon hospitalisation"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">Amyloidosis is an uncommon disease produced by the deposition of fibrillar material that precipitates in the body tissues&#46; The most commonly affected organs are&#58; the kidneys &#40;50&#37;&#41;&#44; heart &#40;40&#37;-50&#37;&#41;&#44; and peripheral nerves &#40;25&#37;&#41;&#44; although it can affect any organ&#46;<span class="elsevierStyleSup">1</span> This disease implies a poor prognosis&#44; with 80&#37; mortality two years after diagnosis&#44; despite treatment&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Here we present two cases of primary amyloidosis that appeared initially in the form of heart failure &#40;HF&#41;&#44; hypotension&#44; and progressive renal failure &#40;RF&#41;&#58; an uncommon form of evolution for this disease&#46;</p><p class="elsevierStylePara">Both cases were female patients &#40;aged 58 and 57 years&#41; who sought emergency treatment due to symptoms of HF&#58; one with right HF and the other with left HF&#46; Both patients also had hypotension and mild oedema upon physical examination&#44; and an initial laboratory analysis revealed previously undiagnosed RF &#40;Table 1&#41; with conserved diuresis&#46; In both cases&#44; an electrocardiogram revealed low-voltage sinus rhythm&#46; Given the state of hypotension and signs of heart failure&#44; both patients underwent electrocardiography that revealed a restrictive pattern of mitral filling&#44; suggestive of hypertrophic cardiomyopathy &#40;as opposed to restrictive&#41;&#46; Simultaneously&#44; we performed an analysis of RF&#44; with ultrasound images revealing the kidneys to be morphologically normal&#46; We determined the protein&#47;creatinine &#40;Cr&#41; ratio&#44; which was 2500mg&#47;g Cr in one patient&#44; and almost normal &#40;66mg&#47;g Cr&#41; in the other patient&#46; Given the finding in both cases of normochromic normocytic anaemia&#44; with elevated sedimentation rates and renal failure&#44; negative sediment results&#44; and a restrictive pattern in ultrasound analyses&#44; we established the preliminary diagnosis of a systemic infiltrative pathology such as amyloidosis&#44; which led to tests for immunoglobulins and light chains in blood and urine samples&#46; The results from these tests revealed a monoclonal gammapathy&#46; We administered myelograms that confirmed the diagnosis of multiple myeloma &#40;in the first case&#44; lambda IgA&#44; and in the second&#44; lambda IgG&#41;&#44; with 24&#37; and 22&#37;-40&#37; infiltration&#44; respectively&#46; Given the suspicion of associated amyloidosis&#44; we performed biopsies of the rectal submucosa&#44; which were positive for Congo red stain tests and birefringence&#44; confirming the diagnosis of AL amyloidosis&#46; Both patients started treatment with bortezomib and prednisone&#44; but the first patient experienced a poor evolution&#44; requiring renal replacement therapy followed by the development of acute pulmonary oedema with cardiogenic shock that was not improved by vasoactive drugs&#44; followed by death after a few weeks&#46;</p><p class="elsevierStylePara">Amyloidosis is a systemic disease that affects several organs at the moment of diagnosis&#46; In primary amyloidosis&#44; the protein deposits include light chains from the immunoglobulins produced by clonal proliferation of plasma cells&#44; primarily due to multiple myeloma&#46; Asymptomatic deposits of amyloid material can be observed in 30&#37; of patients&#44;<span class="elsevierStyleSup">1&#44;2</span> and 10&#37;-15&#37; develop symptomatic AL amyloidosis&#46;<span class="elsevierStyleSup">3&#44;4</span> Both myeloma and amyloidosis can produce renal manifestations&#58; renal involvement in multiple myeloma is multi-factorial&#44; although the most common finding is referred to as &#8220;myeloma kidney&#8221; &#40;60&#37; of cases&#41;&#44; which is characterised by tubulo-interstitial damage that is clinically expressed as acute or chronic RF due to tubular light chain precipitation&#46; The majority of patients progress with proteinuria&#44; which is non-selective in 90&#37; of cases&#44; and 25&#37; of these patients develop nephrotic syndrome&#46; Patients with vascular involvement develop only mild proteinuria&#44; but RF continues to progress due to the decrease in renal flow&#46;</p><p class="elsevierStylePara">The heart is another organ often implicated in amyloidosis &#40;figure 1&#41;&#46; Cardiac involvement can be observed in 50&#37; of patients with AL amyloidosis&#46; Cardiac involvement should be suspected in patients with primarily right HF symptoms&#44; with conserved systolic function and diastolic dysfunction&#46;<span class="elsevierStyleSup">3</span> Pulmonary oedema is not a common complication&#46; Established myocardial damage is evaluated by determining troponin and atrial natriuretic peptide levels&#44; which can be used to monitor response to treatment&#46; In order to confirm the diagnosis of amyloidosis&#44; a positive biopsy test must be produced using Congo red stain in affected tissue&#44; and if cardiac involvement is suspected&#44; a positive cardiac imaging test &#40;echocardiogram or magnetic resonance&#41;&#44; or even an endomyocardial biopsy&#44; which is a relatively safe procedure when performed by experienced technicians&#44; is needed&#46;<span class="elsevierStyleSup">1&#44;5</span></p><p class="elsevierStylePara">There are two critical components that affect the survival of patients with amyloidosis&#58; cardiac involvement and response to treatment&#46;<span class="elsevierStyleSup">3</span> Patients with cardiac involvement have a mean survival of 1&#46;1 years after diagnosis&#44; and a survival less than 6 months if treatment is not provided once the first symptoms of HF are recognised&#44;<span class="elsevierStyleSup">1&#44;3&#44;5&#44;6</span> especially if the signs of heart failure persist when the diagnosis is confirmed&#46; Even when the primary manifestation of the disease is in another organ system&#44; cardiac involvement implies a worse prognosis&#46; Only in select cases of isolated cardiac involvement have heart transplants followed by bone marrow transplants been attempted with positive results&#46;<span class="elsevierStyleSup">4&#44;6</span></p><p class="elsevierStylePara">To conclude&#44; the primary manifestations of AL amyloidosis are in the kidneys and heart&#46; Given a hypotensive patient with progressively deteriorating renal function and ultrasound imaging results indicative of infiltrative cardiomyopathy&#44; vascular amyloidosis should immediately be suspected as a possible diagnosis&#44; and an aetiological examination should be started to rule out associated myeloma&#44; in addition to completing the diagnosis of amyloidosis with a tissue sample analysis&#46; The approach for this disease must be multi-disciplinary&#44; evaluating available diagnostic techniques and treatments under a consensus model&#46; In the first of our two cases&#44; the disease expanded aggressively in its severe form&#44; involving both organs and the vascular system&#44; producing an atrocious prognosis with severely limited treatment options&#46; In the second case&#44; it may have been that the bortezomib was able to supress the associated amyloidosis&#44; given its positive results in treating myeloma&#44; or at least could facilitate the consideration of bone marrow transplantation in patients with a partial response to treatment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11556&#95;108&#95;39794&#95;en&#95;t110&#46;jpg" class="elsevierStyleCrossRefs"><img src="11556_108_39794_en_t110.jpg" alt="Laboratory parameters of the two cases upon hospitalisation"></img></a></p><p class="elsevierStylePara">Table 1&#46; Laboratory parameters of the two cases upon hospitalisation</p><p class="elsevierStylePara"><a href="grande&#47;11556&#95;108&#95;39795&#95;en&#95;pa769ginas&#95;desde10&#46;jpg" class="elsevierStyleCrossRefs"><img src="11556_108_39795_en_pa769ginas_desde10.jpg" alt="Cardiac magnetic resonance&#46; Delayed gadolinium enhancement in the subendocardium"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Cardiac magnetic resonance&#46; Delayed gadolinium enhancement in the subendocardium</p>"
    "pdfFichero" => "P1-E544-S3783-A11556-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11556_108_39794_en_t110.jpg"
            "Alto" => 1979
            "Ancho" => 1442
            "Tamanyo" => 511114
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Laboratory parameters of the two cases upon hospitalisation"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11556_108_39795_en_pa769ginas_desde10.jpg"
            "Alto" => 411
            "Ancho" => 663
            "Tamanyo" => 77311
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Cardiac magnetic resonance&#46; Delayed gadolinium enhancement in the subendocardium"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002115/v0_201502091603/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000006/v0_201502091602/X2013251412002115/v0_201502091603/en/P1-E544-S3783-A11556-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002115?idApp=UINPBA000064"
]