Phenotypic expression in hypertrophic cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance | Revista Portuguesa de Cardiologia (English edition)

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However, the prognostic value of late gadolinium enhancement (LGE) in identifying potentially arrhythmogenic areas of endomyocardial fibrosis is the subject of disagreement.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The aim of this study was to examine the association between LGE on CMR and clinical, imaging and prognostic characteristics in a Portuguese population of HCM patients.MethodsStudy populationWe performed a retrospective analysis of HCM patients followed regularly as outpatients in the cardiology department of a central hospital who underwent CMR with LGE study.Of a population of 78 patients with HCM, 61 underwent CMR. The reasons for not undergoing CMR were the usual ones of ICD or pacemaker, claustrophobia, or patient refusal.The definition of HCM was based on the classic echocardiographic criteria (left ventricular hypertrophy [LVH] without dilatation, maximum wall thickness ≥15 mm) and exclusion of other systemic or local causes of hypertrophy.Eight patients were excluded: five in whom LGE study was not possible, one with a diagnosis of cardiac amyloidosis and two with Noonan syndrome. The final study population was thus composed of 53 patients.Clinical dataThe patients’ clinical data were collected from their medical records by an investigator blinded to the results of CMR.Baseline characteristicsThe following baseline characteristics were recorded: hypertension, diabetes, obstructive sleep apnea, coronary artery disease, atrial fibrillation, syncope, history of sudden death in a first-degree relative aged <45 years, New York Heart Association (NYHA) functional class, medication with beta-blockers or non-dihydropyridine calcium channel blockers, previous myectomy or alcohol septal ablation, pacemaker or ICD, resting electrocardiogram and NT-pro-BNP level.Screening for Fabry disease was performed in 34 (64.1%) of the patients and for common HCM mutations in sarcomere protein genes in 41 (77.4%).Assessment of blood pressure response by exercise testingThirty (56.6%) patients underwent exercise testing using the modified Bruce protocol. A hypotensive response was defined as a rise of ≤20 mmHg or a fall of ≥20 mmHg in blood pressure during exertion.Echocardiographic parametersTransthoracic echocardiography was performed by two experienced observers who were blinded to some of the patients’ clinical data. The following parameters were assessed: left ventricular (LV) diastolic diameter; thickness of the ventricular septum, LV posterior wall and apex; left atrial (LA) volume; presence of a ≥30 mmHg gradient at rest and following provocation; quantification of mitral regurgitation; classification of LV systolic function and diastolic dysfunction.Of the patients with no gradient at rest, 13 (33.4%) underwent exercise echocardiography to determine the presence of a gradient with exercise.Cardiac magnetic resonanceAll CMR studies were performed on a Philips® 1.5 T scanner by three experienced observers who were blinded to some of the patients’ clinical data. The following parameters were assessed: LA area; left ventricular ejection fraction (LVEF); maximum LV wall thickness; and LGE following intravenous gadolinium administration.Follow-upThe study population were followed for a mean of 53.6±53.4 months (4-271).All patients underwent 24-hour Holter ECG monitoring to determine the number of ventricular extrasystoles and of episodes of non-sustained ventricular tachycardia, defined as ≥3 consecutive ventricular complexes lasting <30 s and without hemodynamic compromise.In patients with an ICD, all records of device interrogation were analyzed for appropriate therapies and overdrive pacing triggered by ventricular fibrillation and/or tachycardia.Two endpoints were defined: all-cause death and appropriate ICD therapies.Statistical analysisThe statistical analysis was performed with SPSS for Windows, version 17.0.Nominal variables were expressed as counts and percentages and were compared (combination of frequencies) using the chi-square test. Continuous variables were expressed as means ± standard deviation; the Student's t test was used to compare variables with normal distribution and the Mann–Whitney U test to compare those with non-normal distribution.A value of p<0.05 was considered statistically significant.ResultsCharacteristics of the study populationThe study population consisted of 53 patients, 27 (50.9%) male, with a mean age of 56.4±17.0 years at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of the population. In terms of functional capacity, 29 (54.7%) patients were in NYHA class I, 22 (41.5%) in class II, and two (3.8%) in class III. No patient had undergone myectomy and two had undergone alcohol septal ablation.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the main electrocardiographic alterations.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Of the 34 (64.1%) patients screened for Fabry disease, none had any of the classical mutations.Investigation of HCM mutations in sarcomere protein genes, performed in 41 patients (77.4%), was negative in 12 (29.3%); a classical mutation was identified in nine (21.9%), a mutation of undetermined significance in three (7.3%), and the results are still awaited in 17 (41.5%).Mean NT-pro-BNP, assessed in 29 patients (54.7%), was 3130±5762 pg/ml.Only four (13.3%) of the patients who underwent exercise testing had a hypotensive response.Echocardiographic findingsThe phenotypic distribution of HCM was as follows: asymmetric in 36 (67.9%) patients, apical in 13 (24.5%) and concentric in four (7.5%). Systolic anterior motion of the mitral valve causing obstruction at rest was observed in 20 (37.7%) patients, with an end-systolic gradient of 69.4±27.3 mmHg. Mitral regurgitation was absent in six (11.3%) patients, minimal (grade 1) in 30 (56.6%), mild (grade 2) in 11 (20.8%), moderate (grade 3) in five (9.4%) and severe (grade 4) in one (1.9%).Only seven (13.2%) patients did not present diastolic dysfunction. A pseudonormal pattern was the most common, found in 22 (41.5%) patients, followed by abnormal relaxation in 21 (39.6%); three (5.7%) presented a restrictive pattern.At least mild global systolic dysfunction was identified in seven (13.2%) patients.<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the main continuous echocardiographic variables.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Of the 13 patients who underwent exercise echocardiography, seven (53.8%) developed a significant gradient on exertion (69.3±31.9 mmHg).Cardiac magnetic resonance findingsThe phenotypic characterization of HCM by CMR was similar to that obtained by transthoracic echocardiography, and provided more accurate localization of LVH.<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the main continuous variables assessed by CMR.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>LGE was observed in 24 (45.3%) patients.Factors predicting late gadolinium enhancement on cardiac magnetic resonancePatients with LGE were younger at diagnosis (52.3±16.9 vs. 59.8±16.5 years; p=0.046), and more often had a family history of sudden death (33.3% vs. 3.4%; p=0.008; odds ratio [OR] 13.5).Patients with LGE were more likely to have a history of coronary artery disease (12.5% vs. 0%; p=0.086) and higher NT-pro-BNP levels (5151±7882 vs. 1489±2422 pg/ml; p=0.089).There were no differences between the groups in gender (p=0.669); history of hypertension (p=0.899), diabetes (p=0.532), syncope (p=0.288) or obstructive sleep apnea (p=0.135); presence of an identified mutation (p=0.676); NYHA functional class; previous therapy with beta-blockers (p=0.454) or non-dihydropyridine CCBs (p=0.112); voltage criteria for LVH (p=0.696); or history of atrial fibrillation (p=0.098).There was also no difference between the groups in blood pressure response to exercise testing (p=0.348).Patients with LGE more often presented systolic dysfunction on echocardiography, characterized by LVEF <50% (25.0% vs. 3.4%; p=0.038; OR 9.33) and diastolic dysfunction with pseudonormal (68.2% vs. 29.2%) or restrictive pattern (9.1% vs. 4.2%; p=0.011).<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the continuous echocardiographic variables that predicted LGE.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>No association was seen between the presence of LGE and type of HCM: asymmetrical (p=0.441), apical (p=0.475) and concentric (p=0.844). Similarly, neither the presence of obstruction (p=0.242) nor the severity of mitral regurgitation (p=0.637) was associated with LGE.<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> shows the CMR variables that predicted LGE.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Follow-upPatients were followed for a mean of 53.6±53.4 months (4-271).There were no differences between the groups in detection of non-sustained ventricular tachycardia (20.8% vs. 20.7%; p=0.990), or in the number of ventricular extrasystoles (p=0.503) documented on 24-hour Holter monitoring.During follow-up 11 patients (20.7%) received an ICD for primary prevention due to the presence of one or more classical risk factors. More patients with LGE received ICDs (37.5% vs. 6.9%; p=0.015). An appropriate therapy with overdrive pacing was recorded in only one patient.Two patients died during follow-up, one in each group, both from heart failure.DiscussionCMR is the preferred imaging modality for determining ventricular mass, chamber volume, global systolic function and the pattern and distribution of LVH in HCM patients.<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a> LGE imaging is a particularly valuable method for identifying areas of fibrosis and to determine their extent and distribution.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a>Characteristics of the study populationThe mean age of our population (56.4±17.0 years) was older than in most studies in the literature<a class="elsevierStyleCrossRefs" href="#bib0025">5,11,12</a> and included few patients in the age-group most associated with sudden death (<35 years).Most were asymptomatic or mildly symptomatic, as in other published series.<a class="elsevierStyleCrossRefs" href="#bib0045">9,13–15</a> This highlights the need for new ways to stratify risk of sudden death, since this may be the first clinical manifestation of HCM, years after initial diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>Although asymmetric HCM was the most common pattern in our population (67.9%), there was a high prevalence of apical HCM (24.5%).The mean maximum LV wall thickness on CMR of 19.4±3.8 mm demonstrates that significant LVH can be present even in only mildly symptomatic patients, as reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0065">13–15</a>The prevalence of LV outflow tract obstruction in our population (50.9%) was lower than in the literature,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> but some patients without a gradient at rest did not undergo exercise echocardiography.The percentage of patients with a hypotensive response on exercise testing (13.3%) was also lower than previously reported (25%).<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a>Clinical and prognostic significance of late gadolinium enhancementOur study confirms that the presence of LGE is a common phenotypic characteristic in this population, although its prevalence (45.3%) was lower than that described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0105">21–23</a>The pattern of distribution of LGE does not correspond to the perfusion territories of the epicardial coronary arteries, but is related to areas of LVH and is mid-myocardial in location.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Predictors of LGE were younger age, a family history of sudden death, LVEF <50%, more severe diastolic dysfunction and LA dilatation, and greater maximum LV wall thickness.It is known that the presence and extent of LGE is inversely related to LVEF,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> since LGE is associated with ventricular remodeling that eventually leads to heart failure.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> An association between LGE and maximum LV wall thickness has also been reported.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> LA dilatation, a surrogate marker of diastolic dysfunction, is also associated with LGE.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Mortality in our population, although low, was in all cases of cardiovascular cause (heart failure).As in previous studies,<a class="elsevierStyleCrossRefs" href="#bib0055">11,15</a> it remains to be proved whether LGE is an independent prognostic marker. Maron et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> reported a high prevalence, although not reaching statistical significance, of cardiovascular events during follow-up of 202 patients with HCM and LGE. By contrast, in a study of 220 asymptomatic or only mildly symptomatic HCM patients with a mean follow-up of three years, Bruder et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> showed that LGE was an independent predictor of cardiac death (hazard ratio [HR] 8.6; p=0.038), whereas the presence of one or two clinical risk factors did not reach statistical significance (HR 1.4; p=0.68).In a recent meta-analysis of four studies with a total of 1063 HCM patients, Green et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> confirmed the high prevalence of LGE (60%) and its correlation with adverse cardiovascular events (cardiac death, heart failure death, and all-cause mortality), although it was not associated with sudden death or aborted sudden death and did not add value to traditional clinical risk factors.In a population in which 60% present LGE and the event rate is 1–5%/year, such an association would be difficult to prove. More sophisticated techniques for quantifying LGE would thus improve its prognostic value.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Quantification of the extent of LGE by means of T1-weighted sequences has been validated in other diseases of the myocardium, including ischemic heart disease and dilated cardiomyopathy, and could be of value in HCM.<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a>The European Cardiovascular Magnetic Resonance registry, with a clinical follow-up of at least 12 months, observed only a trend towards better outcome in HCM patients without LGE.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>Study limitationsOur study has several limitations, including the small number of patients and events.Patients with ICDs who did not undergo CMR before device implantation were not included in the study, and it is impossible to know whether their inclusion would have significantly changed its results.Another limitation is the fact that LGE was not quantified, nor was its distribution analyzed.As with all retrospective studies, we were limited to the information available in patients’ medical records.ConclusionsThe presence of LGE emerges as a risk marker, associated with the classical predictors of sudden cardiac death in HCM, particularly a family history of sudden death and greater maximum LV wall thickness. However, larger studies are required to confirm its independent association with clinical events.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres350696" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and Aim" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec332252" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres350695" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução e objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec332253" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Clinical data" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Assessment of blood pressure response by exercise testing" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Echocardiographic parameters" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Cardiac magnetic resonance" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Follow-up" ] ] ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Characteristics of the study population" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Echocardiographic findings" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Cardiac magnetic resonance findings" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Factors predicting late gadolinium enhancement on cardiac magnetic resonance" ] 4 => array:2 [ "identificador" => "sec0080" "titulo" => "Follow-up" ] ] ] 7 => array:3 [ "identificador" => "sec0085" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Characteristics of the study population" ] 1 => array:2 [ "identificador" => "sec0095" "titulo" => "Clinical and prognostic significance of late gadolinium enhancement" ] ] ] 8 => array:2 [ "identificador" => "sec0100" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0110" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0115" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0120" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0125" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0130" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-06-09" "fechaAceptado" => "2013-10-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec332252" "palabras" => array:4 [ 0 => "Hypertrophic cardiomyopathy" 1 => "Late gadolinium enhancement" 2 => "Cardiac magnetic resonance" 3 => "Prognosis" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec332253" "palabras" => array:4 [ 0 => "Miocardiopatia hipertrófica" 1 => "Realce tardio" 2 => "Ressonância magnética cardíaca" 3 => "Prognóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and AimThe prognostic value of late gadolinium enhancement (LGE) for risk stratification of hypertrophic cardiomyopathy (HCM) patients is the subject of disagreement. We set out to examine the association between clinical and morphological variables, risk factors for sudden cardiac death and LGE in HCM patients. MethodsFrom a population of 78 patients with HCM, we studied 53 who underwent cardiac magnetic resonance. They were divided into two groups according to the presence or absence of LGE. Ventricular arrhythmias and morbidity and mortality during follow-up were analyzed. ResultsPatients with LGE were younger at the time of diagnosis (p=0.046) and more often had a family history of sudden death (p=0.008) and known coronary artery disease (p=0.086). On echocardiography they had greater maximum wall thickness (p=0.007) and left atrial area (p=0.037) and volume (p=0.035), and more often presented a restrictive pattern of diastolic dysfunction (p=0.011) with a higher E/E′ ratio (p=0.003) and left ventricular systolic dysfunction (p=0.038). Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings: greater left atrial area (p=0.029) and maximum wall thickness (p<0.001) and lower left ventricular ejection fraction (p=0.056). Patients with LGE more often had an implantable cardioverter-defibrillator (ICD) (p=0.015). At follow-up, no differences were found in the frequency of ventricular arrhythmias, appropriate ICD therapies or mortality. ConclusionsThe presence of LGE emerges as a risk marker, associated with the classical predictors of sudden cardiac death in this population. However, larger studies are required to confirm its independent association with clinical events." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosO valor prognóstico do realce tardio na estratificação dos doentes com miocardiopatia hipertrófica é controverso. Este trabalho pretende avaliar a associação entre a presença de realce tardio na ressonância magnética cardíaca e características clínicas, imagiológicas e prognósticas em doentes com miocardiopatia hipertrófica. MétodosDe 78 doentes com miocardiopatia hipertrófica avaliámos retrospetivamente 53, que realizaram ressonância cardíaca. Os doentes foram divididos em dois grupos, conforme a presença ou ausência de realce tardio. Foi feito seguimento clínico referente a disritmia ventricular e a morbi-mortalidade. ResultadosOs doentes com realce tardio eram mais jovens à data do diagnóstico (p=0,046), mais frequentemente tinham antecedentes familiares de morte súbita (p=0,008) e de doença coronária (p=0,086). No ecocardiograma apresentavam maior espessura parietal máxima (p=0,007); área (p=0,037) e volume indexado da aurícula esquerda (p=0,035); maior frequência de padrão restritivo de disfunção diastólica (p=0,011), com relação E/E’ mais elevada (p=0,003); e disfunção sistólica do ventrículo esquerdo (p=0,038). A ressonância validou as alterações ecocardiográficas associadas à presença de realce tardio: maior área da aurícula esquerda (p=0,029); espessura parietal máxima (p<0,001) e menor fração de ejeção do ventrículo esquerdo (p=0,056). Os doentes com realce tardio mais frequentemente eram portadores de CDI (p=0,015); não havendo diferenças na frequência de episódios de disritmia ventricular, terapias apropriadas de CDI ou mortalidade no seguimento clínico. ConclusõesA presença de realce tardio surge como um marcador de risco, associando-se a fatores já reconhecidos como preditores de morte súbita nesta população. A sua associação independente a eventos clínicos exige o estudo de populações de maior dimensão." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Caetano F, Botelho A, Trigo J, et al. Expressão fenotípica da miocardiopatia hipertrófica e realce tardio na ressonância magnética cardíaca. Rev Port Cardiol. 2014;33:261–266." ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "List of abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:13 [ 0 => array:2 [ "termino" => "AVB" "descripcion" => "atrioventricular block" ] 1 => array:2 [ "termino" => "CCBs" "descripcion" => "calcium channel blockers" ] 2 => array:2 [ "termino" => "CMR" "descripcion" => "cardiac magnetic resonance" ] 3 => array:2 [ "termino" => "HCM" "descripcion" => "hypertrophic cardiomyopathy" ] 4 => array:2 [ "termino" => "HR" "descripcion" => "hazard ratio" ] 5 => array:2 [ "termino" => "ICD" "descripcion" => "implantable cardioverter-defibrillator" ] 6 => array:2 [ "termino" => "LA" "descripcion" => "left atrial" ] 7 => array:2 [ "termino" => "LGE" "descripcion" => "late gadolinium enhancement" ] 8 => array:2 [ "termino" => "LV" "descripcion" => "left ventricular" ] 9 => array:2 [ "termino" => "LVEF" "descripcion" => "left ventricular ejection fraction" ] 10 => array:2 [ "termino" => "LVH" "descripcion" => "left ventricular hypertrophy" ] 11 => array:2 [ "termino" => "OR" "descripcion" => "odds ratio" ] 12 => array:2 [ "termino" => "NYHA" "descripcion" => "New York Heart Association" ] ] ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CCBs: calcium channel blockers." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (71.7%) \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">Type 2 diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (11.3%) \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">Obstructive sleep apnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (11.3%) \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">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (30.2%) \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">History of coronary artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.7%) \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">History of syncope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (15.1%) \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">Family history of sudden death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (17.3%) \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">Beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (69.8%) \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">Non-dihydropyridine CCBs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (13.2%) \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">Permanent pacemaker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524498.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main characteristics of the study population." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AVB: atrioventricular block; LBBB: left bundle branch block; LVH: left ventricular hypertrophy; RBBB: right bundle branch block." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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">Complete RBBB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9.4%) \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">Left anterior hemiblock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (30.2%) \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">Complete LBBB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.9%) \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">Bifascicular block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (15.1%) \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">First-degree AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (24.5%) \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">Second-degree AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (7.5%) \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">Third-degree AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.7%) \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">Voltage criteria for LVH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (69.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524497.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main electrocardiographic alterations." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "A4C: apical 4-chamber view; LA: left atrial; LV: left ventricular." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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">LV diastolic diameter, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.9±7.4 \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">Ventricular septal thickness, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.2±4.3 \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">LV posterior wall thickness, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.2±3.3 \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">Apical thickness (n=13), mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4±6.4 \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">LA area (A4C), mm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.1±5.6 \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">LA volume, mm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.5±20.1 \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">E-wave velocity, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82±0.31 \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">Lateral E′, cm/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7±2.4 \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">E/E′ ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9±6.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524499.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main continuous echocardiographic variables." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "LA: left atrial; LV: left ventricular; LVEF: left ventricular ejection fraction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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">LA area, cm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.07±4.78 \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">LV mass, g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173.7±56.4 \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">Maximum LV wall thickness, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.4±3.8 \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">LVEF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.9±8.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524496.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main continuous cardiac magnetic resonance variables." ] ] 4 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "A4C: apical 4-chamber view; LA: left atrial; LGE: late gadolinium enhancement." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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">Patients with LGE (n=24) \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">Patients without LGE (n=29) \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">p \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">Greater LV wall thickness, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.96±5.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.61±2.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \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">LA area (A4C), cm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.85±5.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.57±4.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.037 \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">Indexed LA volume, cm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.97±20.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.05±18.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.035 \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">E/E′ ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.73±7.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.32±4.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524494.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Continuous echocardiographic variables that predicted late gadolinium enhancement." ] ] 5 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "LA: left atrial; LGE: late gadolinium enhancement; LVEF: left ventricular ejection fraction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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">Patients with LGE (n=24) \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">Patients without LGE (n=29) \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">p \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">Greater LV wall thickness, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.50±4.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.69±2.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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">LA area, cm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.88±3.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.00±5.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.029 \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">LVEF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.4±8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.1±8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.056 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab524495.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cardiac magnetic resonance variables that predicted late gadolinium enhancement." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertrophic cardiomyopathy: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. Maron" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2002" "volumen" => "287" "paginaInicial" => "1308" "paginaFinal" => "1320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11886323" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging techniques in the evaluation and management of hypertrophic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Kelley-Hedgepeth" 1 => "M.S. Maron" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Heart Fail Rep" "fecha" => "2009" "volumen" => "6" "paginaInicial" => "135" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723454" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.J. Maron" 1 => "P. Spirito" 2 => "W.K. 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Original Article

Phenotypic expression in hypertrophic cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance

Expressão fenotípica da miocardiopatia hipertrófica e realce tardio na ressonância magnética cardíaca

Francisca Caetanoa,

Corresponding author

franciscacaetano@sapo.pt

Corresponding author.

, Ana Botelhoa, Joana Trigoa, Joana Silvaa, Inês Almeidaa, Margarida Venânciob, João Paisa, Conceição Sanchesc, António Leitão Marquesa

a Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

b Serviço de Genética Médica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

c Serviço de Radiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0070" class="elsevierStylePara elsevierViewall">Hypertrophic cardiomyopathy &#40;HCM&#41; is a relatively common hereditary disease with a prevalence of 1&#47;500 population&#44; characterized by complexity and a wide spectrum of phenotypic expression and natural history&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Sudden death is the leading cause of mortality in young HCM patients&#44; although the risk is low &#40;about 1&#37;&#47;year&#41;&#59; an implantable cardioverter-defibrillator &#40;ICD&#41; is the only effective preventive measure&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Risk stratification algorithms for predicting sudden death in this population have low positive predictive value and are unclear in their definition of risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Cardiac magnetic resonance &#40;CMR&#41; has become an essential exam in the morphological and functional assessment of HCM&#46; However&#44; the prognostic value of late gadolinium enhancement &#40;LGE&#41; in identifying potentially arrhythmogenic areas of endomyocardial fibrosis is the subject of disagreement&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The aim of this study was to examine the association between LGE on CMR and clinical&#44; imaging and prognostic characteristics in a Portuguese population of HCM patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population</span><p id="par0090" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis of HCM patients followed regularly as outpatients in the cardiology department of a central hospital who underwent CMR with LGE study&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Of a population of 78 patients with HCM&#44; 61 underwent CMR&#46; The reasons for not undergoing CMR were the usual ones of ICD or pacemaker&#44; claustrophobia&#44; or patient refusal&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The definition of HCM was based on the classic echocardiographic criteria &#40;left ventricular hypertrophy &#91;LVH&#93; without dilatation&#44; maximum wall thickness &#8805;15 mm&#41; and exclusion of other systemic or local causes of hypertrophy&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Eight patients were excluded&#58; five in whom LGE study was not possible&#44; one with a diagnosis of cardiac amyloidosis and two with Noonan syndrome&#46; The final study population was thus composed of 53 patients&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The patients&#8217; clinical data were collected from their medical records by an investigator blinded to the results of CMR&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Baseline characteristics</span><p id="par0115" class="elsevierStylePara elsevierViewall">The following baseline characteristics were recorded&#58; hypertension&#44; diabetes&#44; obstructive sleep apnea&#44; coronary artery disease&#44; atrial fibrillation&#44; syncope&#44; history of sudden death in a first-degree relative aged &#60;45 years&#44; New York Heart Association &#40;NYHA&#41; functional class&#44; medication with beta-blockers or non-dihydropyridine calcium channel blockers&#44; previous myectomy or alcohol septal ablation&#44; pacemaker or ICD&#44; resting electrocardiogram and NT-pro-BNP level&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Screening for Fabry disease was performed in 34 &#40;64&#46;1&#37;&#41; of the patients and for common HCM mutations in sarcomere protein genes in 41 &#40;77&#46;4&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Assessment of blood pressure response by exercise testing</span><p id="par0125" class="elsevierStylePara elsevierViewall">Thirty &#40;56&#46;6&#37;&#41; patients underwent exercise testing using the modified Bruce protocol&#46; A hypotensive response was defined as a rise of &#8804;20 mmHg or a fall of &#8805;20 mmHg in blood pressure during exertion&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Echocardiographic parameters</span><p id="par0130" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography was performed by two experienced observers who were blinded to some of the patients&#8217; clinical data&#46; The following parameters were assessed&#58; left ventricular &#40;LV&#41; diastolic diameter&#59; thickness of the ventricular septum&#44; LV posterior wall and apex&#59; left atrial &#40;LA&#41; volume&#59; presence of a &#8805;30 mmHg gradient at rest and following provocation&#59; quantification of mitral regurgitation&#59; classification of LV systolic function and diastolic dysfunction&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Of the patients with no gradient at rest&#44; 13 &#40;33&#46;4&#37;&#41; underwent exercise echocardiography to determine the presence of a gradient with exercise&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Cardiac magnetic resonance</span><p id="par0140" class="elsevierStylePara elsevierViewall">All CMR studies were performed on a Philips<span class="elsevierStyleSup">&#174;</span> 1&#46;5 T scanner by three experienced observers who were blinded to some of the patients&#8217; clinical data&#46; The following parameters were assessed&#58; LA area&#59; left ventricular ejection fraction &#40;LVEF&#41;&#59; maximum LV wall thickness&#59; and LGE following intravenous gadolinium administration&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Follow-up</span><p id="par0145" class="elsevierStylePara elsevierViewall">The study population were followed for a mean of 53&#46;6&#177;53&#46;4 months &#40;4-271&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">All patients underwent 24-hour Holter ECG monitoring to determine the number of ventricular extrasystoles and of episodes of non-sustained ventricular tachycardia&#44; defined as &#8805;3 consecutive ventricular complexes lasting &#60;30 s and without hemodynamic compromise&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In patients with an ICD&#44; all records of device interrogation were analyzed for appropriate therapies and overdrive pacing triggered by ventricular fibrillation and&#47;or tachycardia&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Two endpoints were defined&#58; all-cause death and appropriate ICD therapies&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0165" class="elsevierStylePara elsevierViewall">The statistical analysis was performed with SPSS for Windows&#44; version 17&#46;0&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Nominal variables were expressed as counts and percentages and were compared &#40;combination of frequencies&#41; using the chi-square test&#46; Continuous variables were expressed as means &#177; standard deviation&#59; the Student&#39;s t test was used to compare variables with normal distribution and the Mann&#8211;Whitney U test to compare those with non-normal distribution&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A value of p&#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Characteristics of the study population</span><p id="par0180" class="elsevierStylePara elsevierViewall">The study population consisted of 53 patients&#44; 27 &#40;50&#46;9&#37;&#41; male&#44; with a mean age of 56&#46;4&#177;17&#46;0 years at the time of diagnosis&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of the population&#46; In terms of functional capacity&#44; 29 &#40;54&#46;7&#37;&#41; patients were in NYHA class I&#44; 22 &#40;41&#46;5&#37;&#41; in class II&#44; and two &#40;3&#46;8&#37;&#41; in class III&#46; No patient had undergone myectomy and two had undergone alcohol septal ablation&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the main electrocardiographic alterations&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">Of the 34 &#40;64&#46;1&#37;&#41; patients screened for Fabry disease&#44; none had any of the classical mutations&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Investigation of HCM mutations in sarcomere protein genes&#44; performed in 41 patients &#40;77&#46;4&#37;&#41;&#44; was negative in 12 &#40;29&#46;3&#37;&#41;&#59; a classical mutation was identified in nine &#40;21&#46;9&#37;&#41;&#44; a mutation of undetermined significance in three &#40;7&#46;3&#37;&#41;&#44; and the results are still awaited in 17 &#40;41&#46;5&#37;&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Mean NT-pro-BNP&#44; assessed in 29 patients &#40;54&#46;7&#37;&#41;&#44; was 3130&#177;5762 pg&#47;ml&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Only four &#40;13&#46;3&#37;&#41; of the patients who underwent exercise testing had a hypotensive response&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Echocardiographic findings</span><p id="par0215" class="elsevierStylePara elsevierViewall">The phenotypic distribution of HCM was as follows&#58; asymmetric in 36 &#40;67&#46;9&#37;&#41; patients&#44; apical in 13 &#40;24&#46;5&#37;&#41; and concentric in four &#40;7&#46;5&#37;&#41;&#46; Systolic anterior motion of the mitral valve causing obstruction at rest was observed in 20 &#40;37&#46;7&#37;&#41; patients&#44; with an end-systolic gradient of 69&#46;4&#177;27&#46;3 mmHg&#46; Mitral regurgitation was absent in six &#40;11&#46;3&#37;&#41; patients&#44; minimal &#40;grade 1&#41; in 30 &#40;56&#46;6&#37;&#41;&#44; mild &#40;grade 2&#41; in 11 &#40;20&#46;8&#37;&#41;&#44; moderate &#40;grade 3&#41; in five &#40;9&#46;4&#37;&#41; and severe &#40;grade 4&#41; in one &#40;1&#46;9&#37;&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Only seven &#40;13&#46;2&#37;&#41; patients did not present diastolic dysfunction&#46; A pseudonormal pattern was the most common&#44; found in 22 &#40;41&#46;5&#37;&#41; patients&#44; followed by abnormal relaxation in 21 &#40;39&#46;6&#37;&#41;&#59; three &#40;5&#46;7&#37;&#41; presented a restrictive pattern&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">At least mild global systolic dysfunction was identified in seven &#40;13&#46;2&#37;&#41; patients&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the main continuous echocardiographic variables&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">Of the 13 patients who underwent exercise echocardiography&#44; seven &#40;53&#46;8&#37;&#41; developed a significant gradient on exertion &#40;69&#46;3&#177;31&#46;9 mmHg&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Cardiac magnetic resonance findings</span><p id="par0240" class="elsevierStylePara elsevierViewall">The phenotypic characterization of HCM by CMR was similar to that obtained by transthoracic echocardiography&#44; and provided more accurate localization of LVH&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the main continuous variables assessed by CMR&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0250" class="elsevierStylePara elsevierViewall">LGE was observed in 24 &#40;45&#46;3&#37;&#41; patients&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Factors predicting late gadolinium enhancement on cardiac magnetic resonance</span><p id="par0255" class="elsevierStylePara elsevierViewall">Patients with LGE were younger at diagnosis &#40;52&#46;3&#177;16&#46;9 vs&#46; 59&#46;8&#177;16&#46;5 years&#59; p&#61;0&#46;046&#41;&#44; and more often had a family history of sudden death &#40;33&#46;3&#37; vs&#46; 3&#46;4&#37;&#59; p&#61;0&#46;008&#59; odds ratio &#91;OR&#93; 13&#46;5&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Patients with LGE were more likely to have a history of coronary artery disease &#40;12&#46;5&#37; vs&#46; 0&#37;&#59; p&#61;0&#46;086&#41; and higher NT-pro-BNP levels &#40;5151&#177;7882 vs&#46; 1489&#177;2422 pg&#47;ml&#59; p&#61;0&#46;089&#41;&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">There were no differences between the groups in gender &#40;p&#61;0&#46;669&#41;&#59; history of hypertension &#40;p&#61;0&#46;899&#41;&#44; diabetes &#40;p&#61;0&#46;532&#41;&#44; syncope &#40;p&#61;0&#46;288&#41; or obstructive sleep apnea &#40;p&#61;0&#46;135&#41;&#59; presence of an identified mutation &#40;p&#61;0&#46;676&#41;&#59; NYHA functional class&#59; previous therapy with beta-blockers &#40;p&#61;0&#46;454&#41; or non-dihydropyridine CCBs &#40;p&#61;0&#46;112&#41;&#59; voltage criteria for LVH &#40;p&#61;0&#46;696&#41;&#59; or history of atrial fibrillation &#40;p&#61;0&#46;098&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">There was also no difference between the groups in blood pressure response to exercise testing &#40;p&#61;0&#46;348&#41;&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Patients with LGE more often presented systolic dysfunction on echocardiography&#44; characterized by LVEF &#60;50&#37; &#40;25&#46;0&#37; vs&#46; 3&#46;4&#37;&#59; p&#61;0&#46;038&#59; OR 9&#46;33&#41; and diastolic dysfunction with pseudonormal &#40;68&#46;2&#37; vs&#46; 29&#46;2&#37;&#41; or restrictive pattern &#40;9&#46;1&#37; vs&#46; 4&#46;2&#37;&#59; p&#61;0&#46;011&#41;&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the continuous echocardiographic variables that predicted LGE&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0285" class="elsevierStylePara elsevierViewall">No association was seen between the presence of LGE and type of HCM&#58; asymmetrical &#40;p&#61;0&#46;441&#41;&#44; apical &#40;p&#61;0&#46;475&#41; and concentric &#40;p&#61;0&#46;844&#41;&#46; Similarly&#44; neither the presence of obstruction &#40;p&#61;0&#46;242&#41; nor the severity of mitral regurgitation &#40;p&#61;0&#46;637&#41; was associated with LGE&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> shows the CMR variables that predicted LGE&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Follow-up</span><p id="par0295" class="elsevierStylePara elsevierViewall">Patients were followed for a mean of 53&#46;6&#177;53&#46;4 months &#40;4-271&#41;&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">There were no differences between the groups in detection of non-sustained ventricular tachycardia &#40;20&#46;8&#37; vs&#46; 20&#46;7&#37;&#59; p&#61;0&#46;990&#41;&#44; or in the number of ventricular extrasystoles &#40;p&#61;0&#46;503&#41; documented on 24-hour Holter monitoring&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">During follow-up 11 patients &#40;20&#46;7&#37;&#41; received an ICD for primary prevention due to the presence of one or more classical risk factors&#46; More patients with LGE received ICDs &#40;37&#46;5&#37; vs&#46; 6&#46;9&#37;&#59; p&#61;0&#46;015&#41;&#46; An appropriate therapy with overdrive pacing was recorded in only one patient&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Two patients died during follow-up&#44; one in each group&#44; both from heart failure&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0315" class="elsevierStylePara elsevierViewall">CMR is the preferred imaging modality for determining ventricular mass&#44; chamber volume&#44; global systolic function and the pattern and distribution of LVH in HCM patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> LGE imaging is a particularly valuable method for identifying areas of fibrosis and to determine their extent and distribution&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Characteristics of the study population</span><p id="par0320" class="elsevierStylePara elsevierViewall">The mean age of our population &#40;56&#46;4&#177;17&#46;0 years&#41; was older than in most studies in the literature<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;11&#44;12</span></a> and included few patients in the age-group most associated with sudden death &#40;&#60;35 years&#41;&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Most were asymptomatic or mildly symptomatic&#44; as in other published series&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13&#8211;15</span></a> This highlights the need for new ways to stratify risk of sudden death&#44; since this may be the first clinical manifestation of HCM&#44; years after initial diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">Although asymmetric HCM was the most common pattern in our population &#40;67&#46;9&#37;&#41;&#44; there was a high prevalence of apical HCM &#40;24&#46;5&#37;&#41;&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The mean maximum LV wall thickness on CMR of 19&#46;4&#177;3&#46;8 mm demonstrates that significant LVH can be present even in only mildly symptomatic patients&#44; as reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0340" class="elsevierStylePara elsevierViewall">The prevalence of LV outflow tract obstruction in our population &#40;50&#46;9&#37;&#41; was lower than in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> but some patients without a gradient at rest did not undergo exercise echocardiography&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">The percentage of patients with a hypotensive response on exercise testing &#40;13&#46;3&#37;&#41; was also lower than previously reported &#40;25&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Clinical and prognostic significance of late gadolinium enhancement</span><p id="par0350" class="elsevierStylePara elsevierViewall">Our study confirms that the presence of LGE is a common phenotypic characteristic in this population&#44; although its prevalence &#40;45&#46;3&#37;&#41; was lower than that described in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a></p><p id="par0355" class="elsevierStylePara elsevierViewall">The pattern of distribution of LGE does not correspond to the perfusion territories of the epicardial coronary arteries&#44; but is related to areas of LVH and is mid-myocardial in location&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">Predictors of LGE were younger age&#44; a family history of sudden death&#44; LVEF &#60;50&#37;&#44; more severe diastolic dysfunction and LA dilatation&#44; and greater maximum LV wall thickness&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">It is known that the presence and extent of LGE is inversely related to LVEF&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> since LGE is associated with ventricular remodeling that eventually leads to heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> An association between LGE and maximum LV wall thickness has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> LA dilatation&#44; a surrogate marker of diastolic dysfunction&#44; is also associated with LGE&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">Mortality in our population&#44; although low&#44; was in all cases of cardiovascular cause &#40;heart failure&#41;&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">As in previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15</span></a> it remains to be proved whether LGE is an independent prognostic marker&#46; Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> reported a high prevalence&#44; although not reaching statistical significance&#44; of cardiovascular events during follow-up of 202 patients with HCM and LGE&#46; By contrast&#44; in a study of 220 asymptomatic or only mildly symptomatic HCM patients with a mean follow-up of three years&#44; Bruder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> showed that LGE was an independent predictor of cardiac death &#40;hazard ratio &#91;HR&#93; 8&#46;6&#59; p&#61;0&#46;038&#41;&#44; whereas the presence of one or two clinical risk factors did not reach statistical significance &#40;HR 1&#46;4&#59; p&#61;0&#46;68&#41;&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">In a recent meta-analysis of four studies with a total of 1063 HCM patients&#44; Green et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> confirmed the high prevalence of LGE &#40;60&#37;&#41; and its correlation with adverse cardiovascular events &#40;cardiac death&#44; heart failure death&#44; and all-cause mortality&#41;&#44; although it was not associated with sudden death or aborted sudden death and did not add value to traditional clinical risk factors&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">In a population in which 60&#37; present LGE and the event rate is 1&#8211;5&#37;&#47;year&#44; such an association would be difficult to prove&#46; More sophisticated techniques for quantifying LGE would thus improve its prognostic value&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Quantification of the extent of LGE by means of T1-weighted sequences has been validated in other diseases of the myocardium&#44; including ischemic heart disease and dilated cardiomyopathy&#44; and could be of value in HCM&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">The European Cardiovascular Magnetic Resonance registry&#44; with a clinical follow-up of at least 12 months&#44; observed only a trend towards better outcome in HCM patients without LGE&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Study limitations</span><p id="par0395" class="elsevierStylePara elsevierViewall">Our study has several limitations&#44; including the small number of patients and events&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">Patients with ICDs who did not undergo CMR before device implantation were not included in the study&#44; and it is impossible to know whether their inclusion would have significantly changed its results&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Another limitation is the fact that LGE was not quantified&#44; nor was its distribution analyzed&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">As with all retrospective studies&#44; we were limited to the information available in patients&#8217; medical records&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conclusions</span><p id="par0415" class="elsevierStylePara elsevierViewall">The presence of LGE emerges as a risk marker&#44; associated with the classical predictors of sudden cardiac death in HCM&#44; particularly a family history of sudden death and greater maximum LV wall thickness&#46; However&#44; larger studies are required to confirm its independent association with clinical events&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Ethical disclosures</span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Protection of human and animal subjects</span><p id="par0420" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Confidentiality of data</span><p id="par0425" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Right to privacy and informed consent</span><p id="par0430" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Conflicts of interest</span><p id="par0435" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-09"
    "fechaAceptado" => "2013-10-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec332252"
          "palabras" => array:4 [
            0 => "Hypertrophic cardiomyopathy"
            1 => "Late gadolinium enhancement"
            2 => "Cardiac magnetic resonance"
            3 => "Prognosis"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec332253"
          "palabras" => array:4 [
            0 => "Miocardiopatia hipertr&#243;fica"
            1 => "Realce tardio"
            2 => "Resson&#226;ncia magn&#233;tica card&#237;aca"
            3 => "Progn&#243;stico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The prognostic value of late gadolinium enhancement &#40;LGE&#41; for risk stratification of hypertrophic cardiomyopathy &#40;HCM&#41; patients is the subject of disagreement&#46; We set out to examine the association between clinical and morphological variables&#44; risk factors for sudden cardiac death and LGE in HCM patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From a population of 78 patients with HCM&#44; we studied 53 who underwent cardiac magnetic resonance&#46; They were divided into two groups according to the presence or absence of LGE&#46; Ventricular arrhythmias and morbidity and mortality during follow-up were analyzed&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with LGE were younger at the time of diagnosis &#40;p&#61;0&#46;046&#41; and more often had a family history of sudden death &#40;p&#61;0&#46;008&#41; and known coronary artery disease &#40;p&#61;0&#46;086&#41;&#46; On echocardiography they had greater maximum wall thickness &#40;p&#61;0&#46;007&#41; and left atrial area &#40;p&#61;0&#46;037&#41; and volume &#40;p&#61;0&#46;035&#41;&#44; and more often presented a restrictive pattern of diastolic dysfunction &#40;p&#61;0&#46;011&#41; with a higher E&#47;E&#8242; ratio &#40;p&#61;0&#46;003&#41; and left ventricular systolic dysfunction &#40;p&#61;0&#46;038&#41;&#46; Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings&#58; greater left atrial area &#40;p&#61;0&#46;029&#41; and maximum wall thickness &#40;p&#60;0&#46;001&#41; and lower left ventricular ejection fraction &#40;p&#61;0&#46;056&#41;&#46; Patients with LGE more often had an implantable cardioverter-defibrillator &#40;ICD&#41; &#40;p&#61;0&#46;015&#41;&#46; At follow-up&#44; no differences were found in the frequency of ventricular arrhythmias&#44; appropriate ICD therapies or mortality&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The presence of LGE emerges as a risk marker&#44; associated with the classical predictors of sudden cardiac death in this population&#46; However&#44; larger studies are required to confirm its independent association with clinical events&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O valor progn&#243;stico do realce tardio na estratifica&#231;&#227;o dos doentes com miocardiopatia hipertr&#243;fica &#233; controverso&#46; Este trabalho pretende avaliar a associa&#231;&#227;o entre a presen&#231;a de realce tardio na resson&#226;ncia magn&#233;tica card&#237;aca e caracter&#237;sticas cl&#237;nicas&#44; imagiol&#243;gicas e progn&#243;sticas em doentes com miocardiopatia hipertr&#243;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De 78 doentes com miocardiopatia hipertr&#243;fica avali&#225;mos retrospetivamente 53&#44; que realizaram resson&#226;ncia card&#237;aca&#46; Os doentes foram divididos em dois grupos&#44; conforme a presen&#231;a ou aus&#234;ncia de realce tardio&#46; Foi feito seguimento cl&#237;nico referente a disritmia ventricular e a morbi-mortalidade&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os doentes com realce tardio eram mais jovens &#224; data do diagn&#243;stico &#40;p&#61;0&#44;046&#41;&#44; mais frequentemente tinham antecedentes familiares de morte s&#250;bita &#40;p&#61;0&#44;008&#41; e de doen&#231;a coron&#225;ria &#40;p&#61;0&#44;086&#41;&#46; No ecocardiograma apresentavam maior espessura parietal m&#225;xima &#40;p&#61;0&#44;007&#41;&#59; &#225;rea &#40;p&#61;0&#44;037&#41; e volume indexado da aur&#237;cula esquerda &#40;p&#61;0&#44;035&#41;&#59; maior frequ&#234;ncia de padr&#227;o restritivo de disfun&#231;&#227;o diast&#243;lica &#40;p&#61;0&#44;011&#41;&#44; com rela&#231;&#227;o E&#47;E&#8217; mais elevada &#40;p&#61;0&#44;003&#41;&#59; e disfun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo &#40;p&#61;0&#44;038&#41;&#46; A resson&#226;ncia validou as altera&#231;&#245;es ecocardiogr&#225;ficas associadas &#224; presen&#231;a de realce tardio&#58; maior &#225;rea da aur&#237;cula esquerda &#40;p&#61;0&#44;029&#41;&#59; espessura parietal m&#225;xima &#40;p&#60;0&#44;001&#41; e menor fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;p&#61;0&#44;056&#41;&#46; Os doentes com realce tardio mais frequentemente eram portadores de CDI &#40;p&#61;0&#44;015&#41;&#59; n&#227;o havendo diferen&#231;as na frequ&#234;ncia de epis&#243;dios de disritmia ventricular&#44; terapias apropriadas de CDI ou mortalidade no seguimento cl&#237;nico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A presen&#231;a de realce tardio surge como um marcador de risco&#44; associando-se a fatores j&#225; reconhecidos como preditores de morte s&#250;bita nesta popula&#231;&#227;o&#46; A sua associa&#231;&#227;o independente a eventos cl&#237;nicos exige o estudo de popula&#231;&#245;es de maior dimens&#227;o&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Caetano F&#44; Botelho A&#44; Trigo J&#44; et al&#46; Express&#227;o fenot&#237;pica da miocardiopatia hipertr&#243;fica e realce tardio na resson&#226;ncia magn&#233;tica card&#237;aca&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;261&#8211;266&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:13 [
              0 => array:2 [
                "termino" => "AVB"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">atrioventricular block</p>"
              ]
              1 => array:2 [
                "termino" => "CCBs"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">calcium channel blockers</p>"
              ]
              2 => array:2 [
                "termino" => "CMR"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiac magnetic resonance</p>"
              ]
              3 => array:2 [
                "termino" => "HCM"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">hypertrophic cardiomyopathy</p>"
              ]
              4 => array:2 [
                "termino" => "HR"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">hazard ratio</p>"
              ]
              5 => array:2 [
                "termino" => "ICD"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">implantable cardioverter-defibrillator</p>"
              ]
              6 => array:2 [
                "termino" => "LA"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">left atrial</p>"
              ]
              7 => array:2 [
                "termino" => "LGE"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">late gadolinium enhancement</p>"
              ]
              8 => array:2 [
                "termino" => "LV"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">left ventricular</p>"
              ]
              9 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              10 => array:2 [
                "termino" => "LVH"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">left ventricular hypertrophy</p>"
              ]
              11 => array:2 [
                "termino" => "OR"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">odds ratio</p>"
              ]
              12 => array:2 [
                "termino" => "NYHA"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">New York Heart Association</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CCBs&#58; calcium channel blockers&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;71&#46;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">Type 2 diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;11&#46;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstructive sleep apnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;11&#46;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;30&#46;2&#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">History of coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;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">History of syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;15&#46;1&#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">Family history of sudden death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;17&#46;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;69&#46;8&#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">Non-dihydropyridine CCBs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;13&#46;2&#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">Permanent pacemaker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab524498.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of the study population&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AVB&#58; atrioventricular block&#59; LBBB&#58; left bundle branch block&#59; LVH&#58; left ventricular hypertrophy&#59; RBBB&#58; right bundle branch block&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Complete RBBB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#46;4&#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">Left anterior hemiblock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;30&#46;2&#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">Complete LBBB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;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">Bifascicular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;15&#46;1&#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">First-degree AVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;24&#46;5&#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">Second-degree AVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#46;5&#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">Third-degree AVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;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">Voltage criteria for LVH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;69&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab524497.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Main electrocardiographic alterations&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A4C&#58; apical 4-chamber view&#59; LA&#58; left atrial&#59; LV&#58; left ventricular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">LV diastolic diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;9&#177;7&#46;4&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">Ventricular septal thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2&#177;4&#46;3&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">LV posterior wall thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2&#177;3&#46;3&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">Apical thickness &#40;n&#61;13&#41;&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;4&#177;6&#46;4&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">LA area &#40;A4C&#41;&#44; mm<span class="elsevierStyleSup">2</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1&#177;5&#46;6&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">LA volume&#44; mm<span class="elsevierStyleSup">3</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;5&#177;20&#46;1&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">E-wave velocity&#44; m&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;82&#177;0&#46;31&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">Lateral E&#8242;&#44; cm&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7&#177;2&#46;4&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">E&#47;E&#8242; ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;9&#177;6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab524499.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Main continuous echocardiographic variables&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVEF&#58; left ventricular ejection fraction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">LA area&#44; cm<span class="elsevierStyleSup">2</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;07&#177;4&#46;78&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">LV mass&#44; g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173&#46;7&#177;56&#46;4&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">Maximum LV wall thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;4&#177;3&#46;8&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">LVEF&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;9&#177;8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab524496.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Main continuous cardiac magnetic resonance variables&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">A4C&#58; apical 4-chamber view&#59; LA&#58; left atrial&#59; LGE&#58; late gadolinium enhancement&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Patients with LGE &#40;n&#61;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-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">Patients without LGE &#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-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">p&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">Greater LV wall thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;96&#177;5&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;61&#177;2&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;007&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">LA area &#40;A4C&#41;&#44; cm<span class="elsevierStyleSup">2</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;85&#177;5&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;57&#177;4&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;037&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">Indexed LA volume&#44; cm<span class="elsevierStyleSup">3</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;97&#177;20&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;05&#177;18&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;035&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">E&#47;E&#8242; ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;73&#177;7&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;32&#177;4&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab524494.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Continuous echocardiographic variables that predicted late gadolinium enhancement&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">LA&#58; left atrial&#59; LGE&#58; late gadolinium enhancement&#59; LVEF&#58; left ventricular ejection fraction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Patients with LGE &#40;n&#61;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-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">Patients without LGE &#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-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">p&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">Greater LV wall thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;50&#177;4&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;69&#177;2&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2013.10.045

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Year/Month	Html	Pdf	Total

2024 November	8	7	15
2024 October	37	29	66
2024 September	42	24	66
2024 August	50	27	77
2024 July	40	26	66
2024 June	45	24	69
2024 May	45	17	62
2024 April	21	19	40
2024 March	37	13	50
2024 February	22	26	48
2024 January	23	23	46
2023 December	17	26	43
2023 November	28	28	56
2023 October	38	15	53
2023 September	32	21	53
2023 August	32	15	47
2023 July	22	7	29
2023 June	18	14	32
2023 May	35	18	53
2023 April	24	3	27
2023 March	25	20	45
2023 February	37	23	60
2023 January	20	14	34
2022 December	36	31	67
2022 November	33	29	62
2022 October	25	11	36
2022 September	28	32	60
2022 August	27	34	61
2022 July	31	30	61
2022 June	13	10	23
2022 May	26	34	60
2022 April	22	20	42
2022 March	24	26	50
2022 February	20	23	43
2022 January	19	21	40
2021 December	15	32	47
2021 November	25	36	61
2021 October	29	41	70
2021 September	19	27	46
2021 August	22	33	55
2021 July	22	24	46
2021 June	15	16	31
2021 May	17	26	43
2021 April	24	13	37
2021 March	54	20	74
2021 February	55	11	66
2021 January	25	13	38
2020 December	31	5	36
2020 November	23	14	37
2020 October	18	4	22
2020 September	48	16	64
2020 August	10	8	18
2020 July	41	3	44
2020 June	34	1	35
2020 May	30	4	34
2020 April	39	5	44
2020 March	22	6	28
2020 February	36	29	65
2020 January	29	7	36
2019 December	20	3	23
2019 November	32	3	35
2019 October	28	6	34
2019 September	13	11	24
2019 August	29	2	31
2019 July	23	9	32
2019 June	20	6	26
2019 May	40	6	46
2019 April	24	10	34
2019 March	23	10	33
2019 February	37	11	48
2019 January	26	3	29
2018 December	71	9	80
2018 November	197	7	204
2018 October	459	16	475
2018 September	61	10	71
2018 August	36	9	45
2018 July	46	8	54
2018 June	56	8	64
2018 May	67	13	80
2018 April	70	3	73
2018 March	84	9	93
2018 February	22	11	33
2018 January	30	9	39
2017 December	49	5	54
2017 November	38	15	53
2017 October	47	14	61
2017 September	37	17	54
2017 August	35	14	49
2017 July	26	18	44
2017 June	39	13	52
2017 May	37	13	50
2017 April	31	12	43
2017 March	26	29	55
2017 February	20	5	25
2017 January	19	2	21
2016 December	24	12	36
2016 November	16	4	20
2016 October	28	6	34
2016 September	19	9	28
2016 August	3	2	5
2016 July	12	7	19
2016 June	9	7	16
2016 May	13	4	17
2016 April	29	1	30
2016 March	38	10	48
2016 February	60	23	83
2016 January	48	11	59
2015 December	45	11	56
2015 November	42	8	50
2015 October	42	15	57
2015 September	45	9	54
2015 August	46	11	57
2015 July	35	10	45
2015 June	30	5	35
2015 May	38	9	47
2015 April	36	15	51
2015 March	23	5	28
2015 February	29	10	39
2015 January	22	6	28
2014 December	43	18	61
2014 November	34	15	49
2014 October	30	15	45
2014 September	49	11	60
2014 August	41	25	66
2014 July	76	45	121

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