Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica

La enfermedad renal crónica representa un verdadero estado inflamatorio y está relacionada con múltiples factores de riesgo cardiovascular. La enfermedad arterial coronaria es una de sus principales complicaciones y usualmente ha sido asociada con factores de riesgo cardiovascular no clásicos o prop...

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Autores:
D’Marco, Luis
Cortez, Marie
Salazar, María
Lima-Martínez, Marcos
Bermúdez, Valmore
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Simón Bolívar
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Repositorio Digital USB
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spa
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oai:bonga.unisimon.edu.co:20.500.12442/5056
Acceso en línea:
https://hdl.handle.net/20.500.12442/5056
Palabra clave:
Enfermedad renal crónica
Tejido adiposo epicárdico
Riesgo cardiovascular
Calcificaciones vasculares
Chronic kidney disease
Epicardial adipose tissue
Cardiovascular risk
Vascular calcification
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License
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
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network_acronym_str USIMONBOL2
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dc.title.spa.fl_str_mv Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
dc.title.translated.eng.fl_str_mv Epicardial adipose tissue: A cardiovascular risk marker to evaluate in chronic kidney disease
title Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
spellingShingle Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
Enfermedad renal crónica
Tejido adiposo epicárdico
Riesgo cardiovascular
Calcificaciones vasculares
Chronic kidney disease
Epicardial adipose tissue
Cardiovascular risk
Vascular calcification
title_short Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
title_full Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
title_fullStr Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
title_full_unstemmed Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
title_sort Tejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónica
dc.creator.fl_str_mv D’Marco, Luis
Cortez, Marie
Salazar, María
Lima-Martínez, Marcos
Bermúdez, Valmore
dc.contributor.author.none.fl_str_mv D’Marco, Luis
Cortez, Marie
Salazar, María
Lima-Martínez, Marcos
Bermúdez, Valmore
dc.subject.spa.fl_str_mv Enfermedad renal crónica
Tejido adiposo epicárdico
Riesgo cardiovascular
Calcificaciones vasculares
topic Enfermedad renal crónica
Tejido adiposo epicárdico
Riesgo cardiovascular
Calcificaciones vasculares
Chronic kidney disease
Epicardial adipose tissue
Cardiovascular risk
Vascular calcification
dc.subject.eng.fl_str_mv Chronic kidney disease
Epicardial adipose tissue
Cardiovascular risk
Vascular calcification
description La enfermedad renal crónica representa un verdadero estado inflamatorio y está relacionada con múltiples factores de riesgo cardiovascular. La enfermedad arterial coronaria es una de sus principales complicaciones y usualmente ha sido asociada con factores de riesgo cardiovascular no clásicos o propios de pacientes urémicos como las alteraciones del metabolismo del calcio y el fósforo, entre otros. Evidencia clínica reciente muestra que el depósito de grasa órgano específico, como el tejido adiposo epicárdico, es un factor de riesgo adicional a tener en cuenta en el momento de la evaluación de riesgo cardiovascular en la población general y en los pacientes renales. La interacción directa de este tejido con los vasos coronarios y la consecuente mediación de sustancias proaterogénicas generan un proceso local que termina en la producción de daño endotelial. Aunque la población de enfermos renales ha sido evaluada escasamente, estudios futuros determinarán con precisión si un incremento en la adiposidad epicárdica está verdaderamente asociado a la morbimortalidad cardiovascular en este grupo de riesgo.
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-03-24T20:25:05Z
dc.date.available.none.fl_str_mv 2020-03-24T20:25:05Z
dc.date.issued.none.fl_str_mv 2020
dc.type.eng.fl_str_mv article
dc.type.coarversion.fl_str_mv http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_6501
dc.type.driver.eng.fl_str_mv article
dc.identifier.issn.none.fl_str_mv 02149168
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12442/5056
identifier_str_mv 02149168
url https://hdl.handle.net/20.500.12442/5056
dc.language.iso.spa.fl_str_mv spa
language spa
dc.rights.*.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_16ec
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
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dc.format.mimetype.spa.fl_str_mv pdf
dc.publisher.spa.fl_str_mv Elsevier
dc.source.spa.fl_str_mv Clínica e Investigación en Arteriosclerosis
dc.source.eng.fl_str_mv Clin Investig Arterioscle
Arteri-515 (2020)
institution Universidad Simón Bolívar
dc.source.uri.none.fl_str_mv https://doi.org/10.1016/j.arteri.2019.10.006
bitstream.url.fl_str_mv https://bonga.unisimon.edu.co/bitstreams/464e6c7a-4584-411b-a2c4-9ccd17074aad/download
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spelling D’Marco, Luisb847abd0-611f-4212-9d68-bf44069a7da7Cortez, Marie13c131c6-d238-4b67-92e7-8fe48b49082eSalazar, María15d18e94-9a11-422c-998c-cd6818c77036Lima-Martínez, Marcos9fee00f2-7c52-4239-bd7a-51155826b2d2Bermúdez, Valmore29f9aa18-16a4-4fd3-8ce5-ed94a0b8663a2020-03-24T20:25:05Z2020-03-24T20:25:05Z202002149168https://hdl.handle.net/20.500.12442/5056La enfermedad renal crónica representa un verdadero estado inflamatorio y está relacionada con múltiples factores de riesgo cardiovascular. La enfermedad arterial coronaria es una de sus principales complicaciones y usualmente ha sido asociada con factores de riesgo cardiovascular no clásicos o propios de pacientes urémicos como las alteraciones del metabolismo del calcio y el fósforo, entre otros. Evidencia clínica reciente muestra que el depósito de grasa órgano específico, como el tejido adiposo epicárdico, es un factor de riesgo adicional a tener en cuenta en el momento de la evaluación de riesgo cardiovascular en la población general y en los pacientes renales. La interacción directa de este tejido con los vasos coronarios y la consecuente mediación de sustancias proaterogénicas generan un proceso local que termina en la producción de daño endotelial. Aunque la población de enfermos renales ha sido evaluada escasamente, estudios futuros determinarán con precisión si un incremento en la adiposidad epicárdica está verdaderamente asociado a la morbimortalidad cardiovascular en este grupo de riesgo.Chronic kidney disease represents a true inflammatory state, and is related to multiple cardiovascular risk factors. Coronary artery disease is the major complication, and has usually been associated with non-classical or uraemic related factors that include the disturbance of calcium and phosphorus metabolism, among others. Recent clinical evidence shows that specific body fat deposition like epicardial adipose tissue is an additional factor to consider when evaluating cardiovascular risk in the general population and kidney patients. Direct interaction of this tissue and coronary vessels with consequent mediation of pro-atherogenic substances have a local process ending in endothelial damage. Although the population of renal patients has been poorly evaluated, future studies should determine precisely whether an increase in epicardial fat is truly associated with cardiovascular morbidity and mortality in this risk group.pdfspaElsevierAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/http://purl.org/coar/access_right/c_16ecClínica e Investigación en ArteriosclerosisClin Investig ArterioscleArteri-515 (2020)https://doi.org/10.1016/j.arteri.2019.10.006Enfermedad renal crónicaTejido adiposo epicárdicoRiesgo cardiovascularCalcificaciones vascularesChronic kidney diseaseEpicardial adipose tissueCardiovascular riskVascular calcificationTejido adiposo epicárdico: un marcador de riesgo cardiovascular a evaluar en la enfermedad renal crónicaEpicardial adipose tissue: A cardiovascular risk marker to evaluate in chronic kidney diseasearticlearticlehttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_6501Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. Chronic kidney disease and mortality risk: A systematic review. J Am Soc Nephrol [Internet]. 2006;17:2034---47. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16738019.Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: A statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Hypertension. 2003;42:1050---65.Berl T, Henrich W. Kidney-heart interactions: Epidemiology, pathogenesis, and treatment. Clin J Am Soc Nephrol [Internet]. 2006;1:8---18. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17699186.Kramer H, Toto R, Peshock R, Cooper R, Victor R. Association between chronic kidney disease and coronary artery calcification: The Dallas Heart Study. J Am Soc Nephrol. 2005;16:507---13.Côté N, Pibarot P, Pépin A, Fournier D, Audet A, Arsenault B, et al. Oxidized low-density lipoprotein, angiotensin and increased waist cirumference are associated with valve inflammation in prehypertensive patients with aortic stenosis. Int J Cardiol [Internet]. 2010;145:444---9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19525020. 6Mathieu P, Poirier P, Pibarot P, Lemieux I, Després JP. Visceral obesity: The link among inflammation, hypertension, and cardiovascular disease. Hypertens (Dallas, Tex 1979) [Internet]. 2009;53:577---84. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19237685.Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab [Internet]. 2004;89:2548---56. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/15181022.Bornachea O, Vea A, Llorente-Cortes V. Interplay between epicardial adipose tissue, metabolic and cardiovascular diseases. Clin e Investig en Arterioscler [Internet]. 2018;30:230---9, http://dx.doi.org/10.1016/j.arteri.2018.03.003.Wu Y, Zhang A, Hamilton DJ, Deng T. Epicardial fat in the maintenance of cardiovascular health. Methodist Debakey Cardiovasc J [Internet]. 13(1):20-24. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28413578.Oikawa M, Owada T, Yamauchi H, Misaka T, Machii H, Yamaki T, et al. Epicardial adipose tissue reflects the presence of coronary artery disease: Comparison with abdominal visceral adipose tissue. Biomed Res Int [Internet]. 2015;2015:483982. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25692138.Nagy E, Jermendy AL, Merkely B, Maurovich-Horvat P. Clinical importance of epicardial adipose tissue. Arch Med Sci [Internet]. 2017;13:864---74. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28721155.Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: Anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536---43.De Feyter PJ. Epicardial adipose tissue: An emerging role for the development of coronary atherosclerosis. Clin Cardiol. 2011;34:143---4.Iacobellis G, Bianco AC. Epicardial adipose tissue: Emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab [Internet]. 2011;22:450---7, http://dx.doi.org/10.1016/j.tem.2011.07.003.Iacobellis G, Pistilli D, Gucciardo M, Leonetti F, Miraldi F, Brancaccio G, et al. Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine. 2005;29:251---5.Ueno K, Anzai T, Jinzaki M, Yamada M, Jo Y, Maekawa Y, et al. Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions. Circ J. 2009;73:1927---33.Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G. Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. Am J Cardiol [Internet]. 2013;111:73---8, http://dx.doi.org/10.1016/j.amjcard.2012.08.044.Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ. Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol [Internet]. 2008;102:1602---7, http://dx.doi.org/10.1016/j.amjcard.2008.08.010.Karohl C, D’Marco L, Bellasi A, Raggi P. Hybrid myocardial imaging for risk stratification prior to kidney transplantation: Added value of coronary calcium and epicardial adipose tissue. J Nucl Cardiol. 2013;20:1013---20.Iacobellis G. Epicardial and pericardial fat: Close, but very different. Obesity (Silver Spring) [Internet]. 2009;17:625 [author reply 626-7]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19322142.Rabkin SW. Epicardial fat: Properties, function and relationship to obesity. Obes Rev. 2007;8:253---61.Hajer GR, van Haeften TW, Visseren FLJ. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J [Internet]. 2008;29:2959---71. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18775919.Wang Z, Nakayama T. Inflammation, a link between obesity and cardiovascular disease. Mediators Inflamm [Internet]. 2010;2010:535918. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/20847813.Nakagawa Y, Nishikimi T, Kuwahara K. Atrial and brain natriuretic peptides: Hormones secreted from the heart. Peptides [Internet]. 2019;111:18---25. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/29859763.Nakagawa H, Oberwinkler H, Nikolaev VO, Gaßner B, Umbenhauer S, Wagner H, et al. Atrial natriuretic peptide locally counteracts the deleterious effects of cardiomyocyte mineralocorticoid receptor activation. Circ Heart Fail [Internet]. 2014;7:814---21. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25027872.D’Marco L, Bellasi A, Raggi P. Cardiovascular biomarkers in chronic kidney disease: State of current research and clinical applicability. Dis Markers. 2015;2015:1---16.Bordicchia M, Liu D, Amri E-Z, Ailhaud G, Dessì-Fulgheri P, Zhang C, et al. Cardiac natriuretic peptides act via p38 MAPK to induce the brown fat thermogenic program in mouse and human adipocytes. J Clin Invest [Internet]. 2012;122:1022---36. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22307324.Sengenes C, Stich V, Berlan M, Hejnova J, Lafontan M, Pariskova Z, et al. Increased lipolysis in adipose tissue and lipid mobilization to natriuretic peptides during low-calorie diet in obese women. Int J Obes Relat Metab Disord [Internet]. 2002;26:24---32. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11791143.Matsukawa N, Grzesik WJ, Takahashi N, Pandey KN, Pang S, Yamauchi M, et al. The natriuretic peptide clearance receptor locally modulates the physiological effects of the natriuretic peptide system. Proc Natl Acad Sci U S A [Internet]. 1999;96:7403---8. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/10377427Turkmen K, Kayikcioglu H, Ozbek O, Solak Y, Kayrak M, Samur C, et al. The relationship between epicardial adipose tissue and malnutrition, inflammation, atherosclerosis/calcification syndrome in ESRD patients. Clin J Am Soc Nephrol. 2011;6:1920---5.Kerr JD, Holden RM, Morton AR, Nolan RL, Hopman WM, Pruss CM, et al. Associations of epicardial fat with coronary calcification, insulin resistance, inflammation, and fibroblast growth factor-23 in stage 3-5 chronic kidney disease. BMC Nephrol [Internet]. 2013;14:26. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23351146.Karatas A, Canakci E, Bektas O, Bayrak T, Bayrak A, Altinbas A, et al. Relationship of epicardial fat tissue thickness with oxidant biomarkers in chronic kidney disease. Bratisl Lek Listy [Internet]. 2018;119(9):566-571. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/30226067.D’Marco LG, Bellasi A, Kim S, Chen Z, Block GA, Raggi P. Epicardial adipose tissue predicts mortality in incident hemodialysis patients: A substudy ofthe Renagel in New Dialysis trial. Nephrol Dial Transplant. 2013;28:2586---95.Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Taguchi H, Yoshikawa J, et al. Epicardial adipose tissue accumulation is associated with renal dysfunction and coronary plaque morphology on multidetector computed tomography. Circ J. 2015;80:196---201.Cordeiro AC, Amparo FC, Oliveira MAC, Amodeo C, Smanio P, Pinto IMF, et al. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease. J Intern Med. 2015;278:77---87.Ko SM, Zhang C, Chen Z, D’Marco L, Bellasi A, Stillman AE, et al. Epicardial adipose tissue volume increase in hemodialysis patients treated with sevelamer or calcium-based phosphate binders: A substudy of the Renagel in new dialysis trial. J Nephrol. 2016;29:683---90.Yazbek DC, Carvalho AB, Barros CS, Pestana JOM, Rochitte CE, dos Santos Filho RD, et al. Is there relationship between epicardial fat and cardiovascular parameters in incident kidney transplant patients? A post-hoc analysis. PLoS One. 2018;13:1---11.Gau S, Klinghammer L, Jahn D, Schuhbäck A, Achenbach S, Marwan M. Epicardial fat and coronary artery calcification in patients on long-term hemodialysis. J Comput Assist Tomog [Internet]. 2014;38(5):768-772. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/24879458.Ayan H, Akilli R, Kaya B, Paydas S, Kara E, Cureoglu A. Relationship between scube1 levels and echocardiography and electrocardiography findings and epicardial adipose tissue/carotid intima-media thickness in patients receiving renal replacement therapy. Exp Clin Transplant. 2019;17 Suppl 1:181---7.Sag S, Yildiz A, Gullulu S, Gungoren F, Ozdemir B, Cegilli E, et al. Early atherosclerosis in normotensive patients with autosomal dominant polycystic kidney disease: The relation between epicardial adipose tissue thickness and carotid intima-media thickness. Springerplus [Internet]. 2016;5:211. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/27026905.Bravo Ramírez AM, Chevaile Ramos A, Hurtado Torres GF. [Body composition in chronic kidney disease patients and haemodialysis]. Nutr Hosp [Internet]. 2010;25:245---9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/20449533.Mancini A, Grandaliano G, Magarelli P, Allegretti A. Nutritional status in hemodialysis patients and bioimpedance vector analysis. J Ren Nutr [Internet]. 2003;13:199---204. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/12874744.43. Pupim LB, Ikizler TA. Assessment and monitoring of uremic malnutrition. J Ren Nutr [Internet]. 2004;14:6---19. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/14740325.44. Chazot C, Gassia J-P, di Benedetto A, Cesare S, Ponce P, Marcelli D. Is there any survival advantage of obesity in Southern European haemodialysis patients? Nephrol Dial Transplant [Internet]. 2009;24:2871---6. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19369686.Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW. Body mass index and mortality in ‘‘healthier’’ as compared with ‘‘sicker’’ haemodialysis patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant [Internet]. 2001 Dec;16:2386---94. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11733631.Janssen I, Katzmarzyk PT, Ross R. Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc [Internet]. 2005;53:2112---8. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16398895.Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M. ADHERE Scientific Advisory Committee and Investigators An obesity paradox in acute heart failure: Analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J [Internet]. 2007;153:74---81. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17174642.Ikizler TA. Effects of hemodialysis on protein metabolism. J Ren Nutr [Internet]. 2005;15:39---43. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/15648005.Dai L, Golembiewska E, Lindholm B, Stenvinkel P. Endstage renal disease inflammation and cardiovascular outcomes. Contrib Nephrol [Internet]. 2017;191:32---43. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28910789.50. Naderi N, Kleine C-E, Park C, Hsiung J-T, Soohoo M, Tantisattamo E, et al. Obesity paradox in advanced kidney disease: From bedside to the bench. Prog Cardiovasc Dis [Internet]. 2018;61(2):168-181. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/29981348.51. Park J, Ahmadi SF, Streja E, Molnar MZ, Flegal KM, Gillen D, et al. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis [Internet]. 2014;56:415---25. Disponible en: https://doi.org/10.1016/j.pcad.2013.10.005.CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805https://bonga.unisimon.edu.co/bitstreams/464e6c7a-4584-411b-a2c4-9ccd17074aad/download4460e5956bc1d1639be9ae6146a50347MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8381https://bonga.unisimon.edu.co/bitstreams/c4880087-f2d6-4761-9809-ac3b29a0a47c/download733bec43a0bf5ade4d97db708e29b185MD5320.500.12442/5056oai:bonga.unisimon.edu.co:20.500.12442/50562024-08-14 21:54:46.484http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internacionalmetadata.onlyhttps://bonga.unisimon.edu.coRepositorio Digital Universidad Simón Bolívarrepositorio.digital@unisimon.edu.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