Relationship between severity of pulmonary hypertension and coronary sinus diameter | Revista Portuguesa de Cardiologia (English edition)

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=> array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Relationship between severity of pulmonary hypertension and coronary sinus diameter" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "329" "paginaFinal" => "335" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mustafa Cetin, Musa Cakici, Cemil Zencir, Hakan Tasolar, Ercan Cil, Emrah Yıldız, Mehmet Balli, Sabri Abus, Erdal Akturk" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Mustafa" "apellidos" => "Cetin" "email" => array:1 [ 0 => "drmcetin@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Musa" "apellidos" => "Cakici" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Cemil" "apellidos" => "Zencir" "referencia" => array:1 [ 0 => 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array:3 [ 0 => array:3 [ "entidad" => "Adiyaman University, School of Medicine, Department of Cardiology, Adiyaman, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Kahramanmaras State Hospital, Department of Cardiology, Kahramanmaras, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Adiyaman University, School of Medicine, Department of Pulmonary Medicine, Adiyaman, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Relação entre a gravidade da hipertensão pulmonar e o diâmetro do seio coronário" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => 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Three measurements were obtained at the termination of the CS orifice, 1 cm to its left, and between the orifice and the left side origin." ] ] ] "textoCompleto" => "IntroductionPulmonary hypertension (PH) is routinely diagnosed in cardiology and pulmonary clinics. Chronic PH causes several adaptive changes in the right heart chambers due to pressure overload. Myocardial hypertrophy is the initial adaptive response, followed by progressive contractile dysfunction.<a class="elsevierStyleCrossRef" href="#bib0130">1</a> Chamber dilatation ensues to allow compensatory preload and maintain stroke volume despite reduced fractional shortening. As contractile weakening progresses, clinical evidence of right ventricular (RV) failure occurs, characterized by rising filling pressures, diastolic dysfunction, and diminishing cardiac output.<a class="elsevierStyleCrossRef" href="#bib0135">2</a> As a part of these processes, the inferior vena cava (IVC), which opens into the right atrium (RA), adapts to these changes, which results in reduced collapse with inspiration and dilatation due to pressure overload.The coronary sinus (CS) is a venous structure that drains myocardial blood primarily from the left ventricle (LV) into the RA, which also receives blood from the IVC. CS diameter has been correlated significantly with pulmonary artery systolic pressure (PASP) in patients with PH resulting from chronic lung disease and LV dysfunction.<a class="elsevierStyleCrossRef" href="#bib0140">3</a> In patients with chronic heart failure (CHF), a dilated CS is possibly a part of the process of cardiac remodeling and may provide useful information to predict the severity of CHF and poor functional class.<a class="elsevierStyleCrossRef" href="#bib0145">4</a> Thus, it is unclear whether the underlying cause of CS dilatation is secondary to PH or a part of cardiac remodeling in patients with CHF.In our echocardiographic study, we aimed to investigate the relationship between CS diameter and PASP, and to identify predictors of dilated CS in patients with PH.MethodsStudy patientsThis was a cross-sectional clinical study that included 155 participants in stable sinus rhythm prospectively referred for transthoracic echocardiography (TTE). The study population consisted of 100 patients with chronic PH and 55 control subjects. The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the local Ethics Committee, and informed consent was obtained from all patients.Patients with a possible diagnosis of PH resulting from thrombotic and/or embolic disease, left ventricular (LV) systolic dysfunction, LV wall motion abnormalities and/or dilatation, more than mild LV diastolic dysfunction,<a class="elsevierStyleCrossRef" href="#bib0150">5</a> more than mild aortic and mitral regurgitation, or any grade of valvular stenosis, severe tricuspid regurgitation, renal dysfunction (serum creatinine >1.5 mg/dl), cirrhotic liver disease, or inadequate imaging of the coronary sinus (CS) and/or IVC were excluded from the study. The subjects were divided into three groups according to PASP: patients with PASP ≤35 mmHg (control group, n=55), those with PASP 36–45 mmHg (mild PH group, n=53) and those with PASP >45 mmHg (moderate to severe PH group, n=47).<a class="elsevierStyleCrossRefs" href="#bib0155">6,7</a> PH was defined as values of PASP >35 mmHg.<a class="elsevierStyleCrossRefs" href="#bib0140">3,6–8</a>Echocardiographic measurementsTTE was performed in all patients as a part of the normal clinical examination to clarify the etiology of various symptoms such as shortness of breath or asthenia or reduction in functional capacity to exclude cardiovascular and pulmonary disease, and all patients underwent a comprehensive examination, including M-mode, two-dimensional (2D), conventional Doppler and tissue Doppler echocardiography in partial left decubitus using a GE Vivid E9 system (General Electric, Chicago, IL, USA) with a 2.5–3.5 MHz transducer in accordance with the American Society of Echocardiography (ASE)/European Society of Cardiology (ESC) guidelines.<a class="elsevierStyleCrossRefs" href="#bib0160">7,9,10</a> All measurements were obtained by two experienced echocardiographers, blinded to clinical information and using the same measurement protocol, and averaged.PASP was non-invasively estimated with echo Doppler techniques from peak instantaneous systolic pressure drop from the right ventricle (RV) to the right atrium (RA) and RA pressure (RAP). The RV-RA gradient was estimated by the peak velocity of the tricuspid regurgitant flow signal using the simplified Bernoulli equation (continuous-wave Doppler in apical 4-chamber [A4C] view), while RAP was estimated from end-expiratory diameter and respiratory changes in the IVC in subcostal view.<a class="elsevierStyleCrossRef" href="#bib0180">11</a> A normal IVC diameter (≤2.1 cm) and inspiratory collapse of >50% suggests an estimated RAP of 3 mmHg (range, 0–5 mmHg); a normal IVC diameter without inspiratory collapse of >50% and dilatation (>2.1 cm) with inspiratory collapse (>50%) suggests an estimated RAP of 8 mmHg (range, 5–10 mmHg); and dilatation (>2.1 cm) without inspiratory collapse of >50% suggests an estimated RAP of 15 mmHg.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> PASP was estimated by the formula: 4 v2+RAP.<a class="elsevierStyleCrossRef" href="#bib0185">12</a> The degree of tricuspid regurgitation (TR) was graded as mild, moderate or severe. Mild TR was defined as vena contracta width (the narrowest portion of the jet just downstream from the valve orifice on Doppler echo) of <0.3 cm, and severe TR as greater than 0.7 cm. Moderate TR was defined as a vena contracta width of 0.3–0.69 cm.Left ventricular ejection fraction (LVEF) was measured from A4C view using the modified Simpson's biplane method.<a class="elsevierStyleCrossRef" href="#bib0170">9</a> RV free wall thickness was measured at end-diastole by M-mode echocardiography from the subcostal window, at the level of the tip of the anterior tricuspid leaflet.<a class="elsevierStyleCrossRef" href="#bib0160">7</a>RV end-diastolic and end-systolic area were measured from A4C view using 2D-mode echo<a class="elsevierStyleCrossRef" href="#bib0160">7</a> and fractional area change (FAC) was estimated as (end-diastolic area−end-systolic area)/end-diastolic area×100. Tricuspid annular plane systolic excursion (TAPSE) was measured by positioning the M-mode cursor at the junction of the tricuspid valve (TV) plane with the RV free wall, and was defined as the displacement of the TV plane from end-diastole to end-systole. RV end-diastolic diameters were measured at the inflow tract from A4C view using 2D-mode echo.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Right atrial (RA) area was estimated by planimetry (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Body surface area (BSA) was calculated by the Mosteller formula: BSA=square root (height (cm)×weight (kg))/3600.<a class="elsevierStyleCrossRef" href="#bib0190">13</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>If the transducer is slightly tilted posteriorly to the level of the dorsal wall of the heart in A4C view, the CS and its entry into the RA can be visualized by echocardiography as a sonolucency in the posterior atrioventricular groove. Maximum CS diameter was measured during ventricular systole, since this is when its diameter is at its greatest. Three measurements were obtained, as follows: at the termination of the CS orifice, 1 cm to its left, and between the orifice and the left side origin (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<a class="elsevierStyleCrossRef" href="#bib0145">4</a> Mean CS diameter was derived as (proximal CS+mid CS+distal CS)/3. Intra- and interobserver variability were 3.2% and 4.1%, respectively. In order to exclude the existence of a persistent left superior vena cava, agitated saline contrast was injected in a left arm peripheral vein in patients with a large CS (mean diameter >0.8 cm).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>To measure RV diastolic function, RV inflow was analyzed using pulsed Doppler in A4C view, positioning the sample volume between the tricuspid leaflets at the middle of the tricuspid annulus. The following measurements of RV global filling were determined: E and A peak velocities (in m/s), E/A ratio, and E-wave deceleration time (DT).<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Tissue Doppler was performed using transducer frequencies of 3.5–4.0 MHz, adjusting the spectral pulsed Doppler signal filters until a Nyquist limit of 15–20 cm/s was reached, and using minimal optimal gain. The pulsed Doppler sample volume was subsequently placed at the level of the lateral tricuspid annulus in A4C view. The tissue Doppler pattern of the mitral annulus is characterized by a positive myocardial systolic wave (Sm) and two negative diastolic waves: early (Em) and atrial (Am). Tissue Doppler systolic indices include myocardial peak velocity of Sm (in cm/s), and diastolic indices include myocardial early (Em) and atrial (Am) peak velocities (in cm/s). The E/Em ratio was also calculated.Statistical analysisContinuous data were presented as mean ± SD and categorical data were expressed as numbers and percentages. The Kolmogorov-Smirnov test was used to assess the normality of the distribution of continuous variables. One-way analysis of variance (ANOVA) with the post-hoc Tukey test or the Kruskal-Wallis test was used to compare the three groups. Categorical variables were summarized as percentages and compared with the chi-square test. Correlation analysis was performed using Pearson's and Spearman's correlation tests. To determine independent predictors of dilated CS, multivariate linear regression analysis was performed including age and parameters with p<0.10. A value of p<0.05 was considered statistically significant. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS 17) for Windows (SPSS Inc., Chicago, IL, USA).ResultsThe etiology of PH was chronic obstructive pulmonary disease in 84 patients (84%), interstitial lung disease in seven (7%), alveolar hypoventilation disorders in four (4%), sleep-disordered breathing in three (3%), and idiopathic in two (2%). The baseline demographic and echocardiographic characteristics of the three groups are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were no significant differences between the groups with respect to baseline demographic characteristics, left ventricular 2D, M-mode and pulsed Doppler echocardiographic findings, or LA diameter. Mean PASP, IVC diameter and RAP were significantly different in each group (p<0.001 for all parameters), while mean RA end-systolic area, RV free wall thickness, RV basal diameter, RV end-diastolic and systolic area, and mean CS diameter (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>) were significantly higher in the moderate to severe PH group.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The RV systolic and diastolic function parameters of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. FAC, TAPSE and Sm wave were significantly decreased in the moderate to severe PH group. Tricuspid inflow A and Am wave were similar between the groups (p>0.05). E wave and E/A ratio were significantly lower in the moderate to severe PH group, whereas E/Em ratio was significantly different in each group (p<0.001), and had the highest value in the moderate to severe PH group.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In the correlation analysis, mean CS diameter was significantly correlated with RA area, FAC, RAP, PASP, IVC, LA diameter, right ventricular E/A ratio, DT, Sm wave and E/Em ratio (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). To find independent predictors of CS diameter, a multivariate regression model including age, FAC, RA area, RAP, PASP, moderate TR, IVC, right ventricular E/A ratio, DT, Sm wave and E/Em ratio was constructed. There was no multicollinearity between the selected parameters in the collinearity statistics (lowest tolerance value >0.2). In multivariate analysis, RA area (β=0.475, p<0.001) and PASP (β=0.360, p=0.002) were found to be independent predictors of CS diameter.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionTo the best of our knowledge, this is the first study investigating the relationship between CS diameter and both RV systolic and diastolic function in patients with PH. The main findings of our study were as follows: (1) as distinct from previous studies, the novel finding was that CS diameter was significantly increased only in patients with moderate to severe PH; (2) CS diameter was correlated with RA area, PASP, RAP, and both RV systolic (FAC, Sm wave) and diastolic parameters (E/A ratio, DT, E/Em ratio); (3) multivariate analysis determined that RA area and PASP were independent predictors of CS diameter.The CS is a venous structure located in the posterior groove between the LA and LV. It begins as a continuation of the great cardiac vein and opens into the RA between the IVC and the atrioventricular groove. Its branches include the great, small and middle cardiac veins, as well as the posterior vein of the LV. Although it is easy to visualize, assessment of the CS has been overlooked in routine echocardiographic examination. In patients with CHF, Yuce et al.<a class="elsevierStyleCrossRef" href="#bib0145">4</a> demonstrated that CS dilatation may be a part of the cardiac remodeling process, predicting the severity of chronic heart failure and poor functional capacity. Lee et al.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> found a significant correlation between CS diameter and PASP in a study of patients referred for cardiac resynchronization therapy. There have been few studies investigating the association between CS size and PASP in patients with PH according to our literature search. Mahmud et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> reported a positive correlation of CS diameter with RA size and RA pressure in patients who underwent echocardiography and right heart catheterization. In a similar population, Isaacs et al.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> investigated the relationship between CS dilatation and pulmonary artery (PA) pressures using chest computed tomography (CT). Right heart catheterization was also performed to obtain right-sided pressures in the study population. They reported that CS dilation was associated with increased PA pressures in patients with PH. Gunes et al.<a class="elsevierStyleCrossRef" href="#bib0140">3</a> reported that CS diameter was increased in patients with PH and significantly correlated with PASP, RAP, right-heart chamber volumes, LVEF, and IVC diameter. In contrast to our work, these study populations included patients with PH due to left-sided heart disease and lung disease, and they did not investigate RV diastolic function. All of these studies examined CS dilatation, although whether the cause of CS dilatation was secondary to increased PASP or a part of cardiac remodeling in patients with CHF remains unclear due to the heterogeneity of the study populations. To address this in our study, we excluded patients with PH resulting from left heart disease. In PH patients with normal LV size and function, mean CS diameter was found to be significantly increased only in patients with moderate to severe PH, and was correlated with PASP, RAP, RA area, and both RV systolic and diastolic function.CS size and morphology have also been investigated in patients with supraventricular tachycardia and connection of a persistent left superior vena cava to the CS.<a class="elsevierStyleCrossRefs" href="#bib0210">17–19</a> Recently, Vatankulu et al.<a class="elsevierStyleCrossRef" href="#bib0225">20</a> reported that the RV myocardial performance index, which represents both systolic and diastolic function, was increased in patients with mitral stenosis and correlated with CS dilatation. In our literature review, we found no studies investigating the relationship between CS diameter and RV diastolic function in patients with PH. However, we determined that CS dilatation was significantly correlated with RV systolic (FAC, Sm wave) and diastolic parameters (E/A ratio, DT, E/Em ratio).The ASE/ESC guidelines for the echocardiographic assessment of the right heart in adults<a class="elsevierStyleCrossRef" href="#bib0170">9</a> recommend that RA area should be estimated in patients undergoing assessment of RV or LV dysfunction. Although the RA can be assessed from many different views, quantification of RA size is most commonly performed in A4C view.<a class="elsevierStyleCrossRef" href="#bib0170">9</a> Because of the paucity of standardized RA volume data by 2D echocardiography, routine RA volume measurements are not currently recommended.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> It has been shown that RA area, volume and systolic function increase prior to the development of RV dilatation and systolic dysfunction during chronic pressure overload exposure in PH.<a class="elsevierStyleCrossRef" href="#bib0230">21</a> However, RA volume assessment has not been standardized in the same way as LA volume assessment. In our study, RA area was found to be an independent predictor of a dilated CS rather than RAP, which was indirectly calculated by means of the IVC collapsibility index using echocardiography as in clinical practice. In our view, as RAP can fluctuate over time, RA size may be a better measure of mean RAP and CS dilatation. This may explain why RAP did not remain a significant factor in multivariate regression analysis and suggests that increased RA area and impaired venous drainage secondary to increased PASP may lead to CS dilatation in patients with PH.LimitationsThis was a case-controlled study with a relatively small number of patients. PH is defined as mean pulmonary artery pressure exceeding 25 mmHg at rest as measured by right heart catheterization (RHC).<a class="elsevierStyleCrossRef" href="#bib0235">22</a> However, echocardiography was used in our study to estimate PASP rather than the gold standard of RHC; we could not perform RHC due to ethical concerns. Despite doubts regarding Doppler-derived measurements of PASP,<a class="elsevierStyleCrossRefs" href="#bib0235">22,23</a> it can provide an estimate of PASP since it is a readily available and reliable method for serial measurements<a class="elsevierStyleCrossRef" href="#bib0165">8</a> and remains the most effective non-invasive screening tool for the assessment of PH in a clinical setting.<a class="elsevierStyleCrossRef" href="#bib0245">24</a> Additionally, it has been reported that echocardiographic evidence of PH is associated with reduced survival.<a class="elsevierStyleCrossRef" href="#bib0250">25</a>ConclusionIn this study, we determined that mean CS diameter was only increased significantly in patients with moderate to severe PH, and that RA area and PASP were independent predictors of CS diameter in patients with PH. Our data suggest that increased RA area and impaired venous drainage secondary to increased PASP may lead to CS dilatation in patients with PH. Further studies are needed to support these findings.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 no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres521190" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec541751" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres521191" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec541752" "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 patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Echocardiographic measurements" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-23" "fechaAceptado" => "2014-11-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec541751" "palabras" => array:4 [ 0 => "Pulmonary hypertension" 1 => "Coronary sinus" 2 => "Right atrial area" 3 => "Pulsed-wave tissue Doppler" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec541752" "palabras" => array:4 [ 0 => "Hipertensão pulmonar" 1 => "Seio coronário" 2 => "Área auricular direita" 3 => "Doppler tecidular onda de pulso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectiveWe investigated the relationship between coronary sinus (CS) diameter and pulmonary artery systolic pressure (PASP) in patients with pulmonary hypertension (PH) and normal left ventricular systolic function. MethodsA total of 155 participants referred for transthoracic echocardiography were included in the study. The study population consisted of 100 patients with chronic PH and 55 control subjects. Patients with PH were divided into two groups according to PASP: those with PASP 36–45 mmHg, the mild PH group (n=53); and those with PASP >45 mmHg, the moderate to severe PH group (n=47). CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula: mean CS=(proximal CS+mid CS+distal CS)/3. ResultsMean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group (1.12±0.2 cm vs. 0.82±0.1 cm and 0.87±0.1 cm, respectively; p<0.001). It was significantly correlated with right atrial (RA) area (r=0.674, p<0.001), RA pressure (r=0.458, p<0.001), PASP (r=0.562, p<0.001), inferior vena cava diameter (r=0.416, p<0.001), right ventricular E/A ratio (r=−0.290, p<0.001), and E/Em ratio (r=0.235, p=0.004). RA area (β=0.475, p<0.001) and PASP (β=0.360, p=0.002) were found to be independent predictors of CS diameter. ConclusionsA dilated CS was associated with moderate to severe pulmonary hypertension, and RA area and PASP were independent predictors of CS diameter." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosOs autores analisaram a relação entre o diâmetro do seio coronário (SC) e a pressão sistólica arterial pulmonar (PSAP) em doentes com hipertensão pulmonar (HP) que apresentaram funções sistólicas ventriculares esquerdas normais. MétodosUm total de 155 participantes referidos para ecocardiografia transtorácica foram incluídos no estudo. A população do estudo é composta por 100 doentes com HP crónica e 55 indivíduos no grupo controlo. Os doentes com HP foram divididos em dois grupos de acordo com a PSAP. Os doentes que tiveram PSAP de 36 a 45 mmHg foram definidos como o grupo de HP ligeiro (n = 53) e aqueles com PSAP > 45 mmHg foram selecionados como o grupo de HP moderada-grave (n = 47). O diâmetro do SC foi medido desde o sulco auriculoventricular posterior na incidência apical quarto câmaras durante a sístole ventricular de acordo com a fórmula: media do SC = (SC proximal + SC médio + SC distal)/3. ResultadosO diâmetro médio do SC foi significativamente superior no grupo da HP moderada –grave do que no grupo controlo e no grupo da HP suave (1,12±0,2 cm versus 0,82±0,1 cm e 0,87±0,1 cm; p <0,001, respetivamente). Verificou-se uma correlação, estatisticamente significativa, com a área da aurícula direita (AD) (r = 0,674, p < 0,001), pressão da AD (r = 0,458, p < 0,001), PSAP (R = 0,562, p < 0,001), veia cava inferior (r = 0,416, p < 0,001), rácio ventricular direito E/A (r = −0,290, p < 0,001) e rácio E/Em (r = 0,235, p = 0,004). Área da AD (β = 0,475, p < 0,001) e PSAP (β = 0,360, p = 0,002) foram encontradas como fatores preditores independentes do diâmetro do SC. ConclusõesO SC dilatado foi associado à hipertensão pulmonar moderada a grave e a área da AD e da PSAP foram fatores preditores independentes do diâmetro do SC." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 996 "Tamanyo" => 80164 ] ] "descripcion" => array:1 [ "en" => "Measurement of right atrial area using the planimetry method from apical 4-chamber view. The green arrow shows this patient's right atrial area." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 996 "Tamanyo" => 79264 ] ] "descripcion" => array:1 [ "en" => "Measurement of coronary sinus (CS) diameter. Three measurements were obtained at the termination of the CS orifice, 1 cm to its left, and between the orifice and the left side origin." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 763 "Ancho" => 973 "Tamanyo" => 53356 ] ] "descripcion" => array:1 [ "en" => "Error bar graph of mean coronary sinus diameter in the three groups. CI: confidence interval; CS: coronary sinus; PH: pulmonary hypertension." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "BMI: body mass index; BSA: body surface area; CAD: coronary artery disease; CS: coronary sinus; HTN: hypertension; IVC: inferior vena cava; LA: left atrial; LV: left ventricular; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LVH: left ventricular hypertrophy; PASP: pulmonary artery systolic pressure; RA: right atrial; RAP: right atrial pressure; RV: right ventricular; TAPSE: tricuspid annular plane systolic excursion; TR: tricuspid regurgitation.Data presented as n (%) or mean ± SD." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (1–2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (1–3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (2–3) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (n=55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (n=53) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (n=47) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.9±13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.6±14.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.900 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.235 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.106 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (72.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (58.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (68.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.121 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.610 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.324 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.564 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.573 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HTN, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (32.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.892 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.218 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.275 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoker, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (19.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.923 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.914 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.842 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CAD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.686 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.552 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.842 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.9±4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.932 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.871 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BSA (m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.79±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.81±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.76±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.714 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.679 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.255 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.3±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.7±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.8±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.081 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.703 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.371 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVH, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.161 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.661 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.361 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEDD (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.76±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.78±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.67±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.823 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.301 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.128 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LA diameter (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.58±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.61±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.64±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.913 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.576 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.818 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E/A ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.790 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.994 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.859 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RA end-systolic area (cm2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.1±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.3±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV free wall thickness (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV basal diameter (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.883 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV end-diastolic area (cm2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9±2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.8±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.302 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV end-systolic area (cm2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.9±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.357 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PASP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.1±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.9±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RAP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IVC diameter (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.75±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CS mean diameter (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.12±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mild TR, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (60.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Moderate TR, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (39.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (74.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab841628.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Controls." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Mild PH." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Moderate to severe PH." ] ] ] "descripcion" => array:1 [ "en" => "Baseline demographic and echocardiographic characteristics of the study population." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Am: myocardial atrial peak velocity; Em: myocardial early peak velocity; Sm: myocardial systolic wave velocity. Other abbreviations as in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.Data presented as n (%) or mean ± SD." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (1–2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (1–3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p (2–3) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> (n=55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> (n=53) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> (n=47) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Systolic function</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV fractional area change (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.9±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6±6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.9±12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.937 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TAPSE (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.881 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sm wave (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.3±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.391 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.228 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Diastolic function</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E wave (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.1±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.3±7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.3±8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.856 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A wave (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.6±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.7±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.2±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.591 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.359 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.908 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Deceleration time (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186.8±26.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">192.9±33.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">199.3±27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.523 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.837 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E/A ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.05±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.672 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Em wave (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.1±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Am wave (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.7±4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.956 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.507 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.685 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E/Em ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab841627.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Controls." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Mild PH." ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "Moderate to severe PH." ] ] ] "descripcion" => array:1 [ "en" => "Right ventricular systolic and diastolic function parameters." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Em: myocardial early peak velocity; Sm: myocardial systolic wave velocity. Other abbreviations as in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">r \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LA diameter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.051 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.527 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.118 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.030 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.708 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.769 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV end-systolic area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.118 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV end-diastolic area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.034 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.675 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RV fractional area change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RA end-systolic area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.674 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.458 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PASP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.562 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.416 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TAPSE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.043 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.592 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Right ventricular parameters</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E/A ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.290 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Deceleration time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.214 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.186 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E/Em ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab841626.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association of mean coronary sinus diameter and other parameters." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversible pulmonary trunk banding. 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Original Article

Relationship between severity of pulmonary hypertension and coronary sinus diameter

Relação entre a gravidade da hipertensão pulmonar e o diâmetro do seio coronário

Mustafa Cetina,

Corresponding author

drmcetin@gmail.com

Corresponding author.

, Musa Cakicia, Cemil Zencirb, Hakan Tasolara, Ercan Cilc, Emrah Yıldızb, Mehmet Ballia, Sabri Abusa, Erdal Akturka

a Adiyaman University, School of Medicine, Department of Cardiology, Adiyaman, Turkey

b Kahramanmaras State Hospital, Department of Cardiology, Kahramanmaras, Turkey

c Adiyaman University, School of Medicine, Department of Pulmonary Medicine, Adiyaman, Turkey

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            "entidad" => "Adiyaman University&#44; School of Medicine&#44; Department of Cardiology&#44; Adiyaman&#44; Turkey"
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            "entidad" => "Kahramanmaras State Hospital&#44; Department of Cardiology&#44; Kahramanmaras&#44; Turkey"
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            "entidad" => "Adiyaman University&#44; School of Medicine&#44; Department of Pulmonary Medicine&#44; Adiyaman&#44; Turkey"
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            "identificador" => "aff0015"
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        "titulo" => "Rela&#231;&#227;o entre a gravidade da hipertens&#227;o pulmonar e o di&#226;metro do seio coron&#225;rio"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Measurement of coronary sinus &#40;CS&#41; diameter&#46; Three measurements were obtained at the termination of the CS orifice&#44; 1 cm to its left&#44; and between the orifice and the left side origin&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary hypertension &#40;PH&#41; is routinely diagnosed in cardiology and pulmonary clinics&#46; Chronic PH causes several adaptive changes in the right heart chambers due to pressure overload&#46; Myocardial hypertrophy is the initial adaptive response&#44; followed by progressive contractile dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Chamber dilatation ensues to allow compensatory preload and maintain stroke volume despite reduced fractional shortening&#46; As contractile weakening progresses&#44; clinical evidence of right ventricular &#40;RV&#41; failure occurs&#44; characterized by rising filling pressures&#44; diastolic dysfunction&#44; and diminishing cardiac output&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> As a part of these processes&#44; the inferior vena cava &#40;IVC&#41;&#44; which opens into the right atrium &#40;RA&#41;&#44; adapts to these changes&#44; which results in reduced collapse with inspiration and dilatation due to pressure overload&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The coronary sinus &#40;CS&#41; is a venous structure that drains myocardial blood primarily from the left ventricle &#40;LV&#41; into the RA&#44; which also receives blood from the IVC&#46; CS diameter has been correlated significantly with pulmonary artery systolic pressure &#40;PASP&#41; in patients with PH resulting from chronic lung disease and LV dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> In patients with chronic heart failure &#40;CHF&#41;&#44; a dilated CS is possibly a part of the process of cardiac remodeling and may provide useful information to predict the severity of CHF and poor functional class&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> Thus&#44; it is unclear whether the underlying cause of CS dilatation is secondary to PH or a part of cardiac remodeling in patients with CHF&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In our echocardiographic study&#44; we aimed to investigate the relationship between CS diameter and PASP&#44; and to identify predictors of dilated CS in patients with PH&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a cross-sectional clinical study that included 155 participants in stable sinus rhythm prospectively referred for transthoracic echocardiography &#40;TTE&#41;&#46; The study population consisted of 100 patients with chronic PH and 55 control subjects&#46; The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the local Ethics Committee&#44; and informed consent was obtained from all patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with a possible diagnosis of PH resulting from thrombotic and&#47;or embolic disease&#44; left ventricular &#40;LV&#41; systolic dysfunction&#44; LV wall motion abnormalities and&#47;or dilatation&#44; more than mild LV diastolic dysfunction&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> more than mild aortic and mitral regurgitation&#44; or any grade of valvular stenosis&#44; severe tricuspid regurgitation&#44; renal dysfunction &#40;serum creatinine &#62;1&#46;5 mg&#47;dl&#41;&#44; cirrhotic liver disease&#44; or inadequate imaging of the coronary sinus &#40;CS&#41; and&#47;or IVC were excluded from the study&#46; The subjects were divided into three groups according to PASP&#58; patients with PASP &#8804;35 mmHg &#40;control group&#44; n&#61;55&#41;&#44; those with PASP 36&#8211;45 mmHg &#40;mild PH group&#44; n&#61;53&#41; and those with PASP &#62;45 mmHg &#40;moderate to severe PH group&#44; n&#61;47&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;7</span></a> PH was defined as values of PASP &#62;35 mmHg&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#44;6&#8211;8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Echocardiographic measurements</span><p id="par0030" class="elsevierStylePara elsevierViewall">TTE was performed in all patients as a part of the normal clinical examination to clarify the etiology of various symptoms such as shortness of breath or asthenia or reduction in functional capacity to exclude cardiovascular and pulmonary disease&#44; and all patients underwent a comprehensive examination&#44; including M-mode&#44; two-dimensional &#40;2D&#41;&#44; conventional Doppler and tissue Doppler echocardiography in partial left decubitus using a GE Vivid E9 system &#40;General Electric&#44; Chicago&#44; IL&#44; USA&#41; with a 2&#46;5&#8211;3&#46;5 MHz transducer in accordance with the American Society of Echocardiography &#40;ASE&#41;&#47;European Society of Cardiology &#40;ESC&#41; guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> All measurements were obtained by two experienced echocardiographers&#44; blinded to clinical information and using the same measurement protocol&#44; and averaged&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">PASP was non-invasively estimated with echo Doppler techniques from peak instantaneous systolic pressure drop from the right ventricle &#40;RV&#41; to the right atrium &#40;RA&#41; and RA pressure &#40;RAP&#41;&#46; The RV-RA gradient was estimated by the peak velocity of the tricuspid regurgitant flow signal using the simplified Bernoulli equation &#40;continuous-wave Doppler in apical 4-chamber &#91;A4C&#93; view&#41;&#44; while RAP was estimated from end-expiratory diameter and respiratory changes in the IVC in subcostal view&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> A normal IVC diameter &#40;&#8804;2&#46;1 cm&#41; and inspiratory collapse of &#62;50&#37; suggests an estimated RAP of 3 mmHg &#40;range&#44; 0&#8211;5 mmHg&#41;&#59; a normal IVC diameter without inspiratory collapse of &#62;50&#37; and dilatation &#40;&#62;2&#46;1 cm&#41; with inspiratory collapse &#40;&#62;50&#37;&#41; suggests an estimated RAP of 8 mmHg &#40;range&#44; 5&#8211;10 mmHg&#41;&#59; and dilatation &#40;&#62;2&#46;1 cm&#41; without inspiratory collapse of &#62;50&#37; suggests an estimated RAP of 15 mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> PASP was estimated by the formula&#58; 4 v<span class="elsevierStyleSup">2</span>&#43;RAP&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> The degree of tricuspid regurgitation &#40;TR&#41; was graded as mild&#44; moderate or severe&#46; Mild TR was defined as vena contracta width &#40;the narrowest portion of the jet just downstream from the valve orifice on Doppler echo&#41; of &#60;0&#46;3 cm&#44; and severe TR as greater than 0&#46;7 cm&#46; Moderate TR was defined as a vena contracta width of 0&#46;3&#8211;0&#46;69 cm&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Left ventricular ejection fraction &#40;LVEF&#41; was measured from A4C view using the modified Simpson&#39;s biplane method&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> RV free wall thickness was measured at end-diastole by M-mode echocardiography from the subcostal window&#44; at the level of the tip of the anterior tricuspid leaflet&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">RV end-diastolic and end-systolic area were measured from A4C view using 2D-mode echo<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> and fractional area change &#40;FAC&#41; was estimated as &#40;end-diastolic area&#8722;end-systolic area&#41;&#47;end-diastolic area&#215;100&#46; Tricuspid annular plane systolic excursion &#40;TAPSE&#41; was measured by positioning the M-mode cursor at the junction of the tricuspid valve &#40;TV&#41; plane with the RV free wall&#44; and was defined as the displacement of the TV plane from end-diastole to end-systole&#46; RV end-diastolic diameters were measured at the inflow tract from A4C view using 2D-mode echo&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Right atrial &#40;RA&#41; area was estimated by planimetry &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Body surface area &#40;BSA&#41; was calculated by the Mosteller formula&#58; BSA&#61;square root &#40;height &#40;cm&#41;&#215;weight &#40;kg&#41;&#41;&#47;3600&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">If the transducer is slightly tilted posteriorly to the level of the dorsal wall of the heart in A4C view&#44; the CS and its entry into the RA can be visualized by echocardiography as a sonolucency in the posterior atrioventricular groove&#46; Maximum CS diameter was measured during ventricular systole&#44; since this is when its diameter is at its greatest&#46; Three measurements were obtained&#44; as follows&#58; at the termination of the CS orifice&#44; 1 cm to its left&#44; and between the orifice and the left side origin &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> Mean CS diameter was derived as &#40;proximal CS&#43;mid CS&#43;distal CS&#41;&#47;3&#46; Intra- and interobserver variability were 3&#46;2&#37; and 4&#46;1&#37;&#44; respectively&#46; In order to exclude the existence of a persistent left superior vena cava&#44; agitated saline contrast was injected in a left arm peripheral vein in patients with a large CS &#40;mean diameter &#62;0&#46;8 cm&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">To measure RV diastolic function&#44; RV inflow was analyzed using pulsed Doppler in A4C view&#44; positioning the sample volume between the tricuspid leaflets at the middle of the tricuspid annulus&#46; The following measurements of RV global filling were determined&#58; E and A peak velocities &#40;in m&#47;s&#41;&#44; E&#47;A ratio&#44; and E-wave deceleration time &#40;DT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Tissue Doppler was performed using transducer frequencies of 3&#46;5&#8211;4&#46;0 MHz&#44; adjusting the spectral pulsed Doppler signal filters until a Nyquist limit of 15&#8211;20 cm&#47;s was reached&#44; and using minimal optimal gain&#46; The pulsed Doppler sample volume was subsequently placed at the level of the lateral tricuspid annulus in A4C view&#46; The tissue Doppler pattern of the mitral annulus is characterized by a positive myocardial systolic wave &#40;Sm&#41; and two negative diastolic waves&#58; early &#40;Em&#41; and atrial &#40;Am&#41;&#46; Tissue Doppler systolic indices include myocardial peak velocity of Sm &#40;in cm&#47;s&#41;&#44; and diastolic indices include myocardial early &#40;Em&#41; and atrial &#40;Am&#41; peak velocities &#40;in cm&#47;s&#41;&#46; The E&#47;Em ratio was also calculated&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Continuous data were presented as mean &#177; SD and categorical data were expressed as numbers and percentages&#46; The Kolmogorov-Smirnov test was used to assess the normality of the distribution of continuous variables&#46; One-way analysis of variance &#40;ANOVA&#41; with the post-hoc Tukey test or the Kruskal-Wallis test was used to compare the three groups&#46; Categorical variables were summarized as percentages and compared with the chi-square test&#46; Correlation analysis was performed using Pearson&#39;s and Spearman&#39;s correlation tests&#46; To determine independent predictors of dilated CS&#44; multivariate linear regression analysis was performed including age and parameters with p&#60;0&#46;10&#46; A value of p&#60;0&#46;05 was considered statistically significant&#46; Statistical analyses were conducted using Statistical Package for the Social Sciences &#40;SPSS 17&#41; for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The etiology of PH was chronic obstructive pulmonary disease in 84 patients &#40;84&#37;&#41;&#44; interstitial lung disease in seven &#40;7&#37;&#41;&#44; alveolar hypoventilation disorders in four &#40;4&#37;&#41;&#44; sleep-disordered breathing in three &#40;3&#37;&#41;&#44; and idiopathic in two &#40;2&#37;&#41;&#46; The baseline demographic and echocardiographic characteristics of the three groups are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no significant differences between the groups with respect to baseline demographic characteristics&#44; left ventricular 2D&#44; M-mode and pulsed Doppler echocardiographic findings&#44; or LA diameter&#46; Mean PASP&#44; IVC diameter and RAP were significantly different in each group &#40;p&#60;0&#46;001 for all parameters&#41;&#44; while mean RA end-systolic area&#44; RV free wall thickness&#44; RV basal diameter&#44; RV end-diastolic and systolic area&#44; and mean CS diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41; were significantly higher in the moderate to severe PH group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The RV systolic and diastolic function parameters of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; FAC&#44; TAPSE and Sm wave were significantly decreased in the moderate to severe PH group&#46; Tricuspid inflow A and Am wave were similar between the groups &#40;p&#62;0&#46;05&#41;&#46; E wave and E&#47;A ratio were significantly lower in the moderate to severe PH group&#44; whereas E&#47;Em ratio was significantly different in each group &#40;p&#60;0&#46;001&#41;&#44; and had the highest value in the moderate to severe PH group&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">In the correlation analysis&#44; mean CS diameter was significantly correlated with RA area&#44; FAC&#44; RAP&#44; PASP&#44; IVC&#44; LA diameter&#44; right ventricular E&#47;A ratio&#44; DT&#44; Sm wave and E&#47;Em ratio &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; To find independent predictors of CS diameter&#44; a multivariate regression model including age&#44; FAC&#44; RA area&#44; RAP&#44; PASP&#44; moderate TR&#44; IVC&#44; right ventricular E&#47;A ratio&#44; DT&#44; Sm wave and E&#47;Em ratio was constructed&#46; There was no multicollinearity between the selected parameters in the collinearity statistics &#40;lowest tolerance value &#62;0&#46;2&#41;&#46; In multivariate analysis&#44; RA area &#40;&#946;&#61;0&#46;475&#44; p&#60;0&#46;001&#41; and PASP &#40;&#946;&#61;0&#46;360&#44; p&#61;0&#46;002&#41; were found to be independent predictors of CS diameter&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first study investigating the relationship between CS diameter and both RV systolic and diastolic function in patients with PH&#46; The main findings of our study were as follows&#58; &#40;1&#41; as distinct from previous studies&#44; the novel finding was that CS diameter was significantly increased only in patients with moderate to severe PH&#59; &#40;2&#41; CS diameter was correlated with RA area&#44; PASP&#44; RAP&#44; and both RV systolic &#40;FAC&#44; Sm wave&#41; and diastolic parameters &#40;E&#47;A ratio&#44; DT&#44; E&#47;Em ratio&#41;&#59; &#40;3&#41; multivariate analysis determined that RA area and PASP were independent predictors of CS diameter&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The CS is a venous structure located in the posterior groove between the LA and LV&#46; It begins as a continuation of the great cardiac vein and opens into the RA between the IVC and the atrioventricular groove&#46; Its branches include the great&#44; small and middle cardiac veins&#44; as well as the posterior vein of the LV&#46; Although it is easy to visualize&#44; assessment of the CS has been overlooked in routine echocardiographic examination&#46; In patients with CHF&#44; Yuce et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> demonstrated that CS dilatation may be a part of the cardiac remodeling process&#44; predicting the severity of chronic heart failure and poor functional capacity&#46; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> found a significant correlation between CS diameter and PASP in a study of patients referred for cardiac resynchronization therapy&#46; There have been few studies investigating the association between CS size and PASP in patients with PH according to our literature search&#46; Mahmud et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> reported a positive correlation of CS diameter with RA size and RA pressure in patients who underwent echocardiography and right heart catheterization&#46; In a similar population&#44; Isaacs et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> investigated the relationship between CS dilatation and pulmonary artery &#40;PA&#41; pressures using chest computed tomography &#40;CT&#41;&#46; Right heart catheterization was also performed to obtain right-sided pressures in the study population&#46; They reported that CS dilation was associated with increased PA pressures in patients with PH&#46; Gunes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> reported that CS diameter was increased in patients with PH and significantly correlated with PASP&#44; RAP&#44; right-heart chamber volumes&#44; LVEF&#44; and IVC diameter&#46; In contrast to our work&#44; these study populations included patients with PH due to left-sided heart disease and lung disease&#44; and they did not investigate RV diastolic function&#46; All of these studies examined CS dilatation&#44; although whether the cause of CS dilatation was secondary to increased PASP or a part of cardiac remodeling in patients with CHF remains unclear due to the heterogeneity of the study populations&#46; To address this in our study&#44; we excluded patients with PH resulting from left heart disease&#46; In PH patients with normal LV size and function&#44; mean CS diameter was found to be significantly increased only in patients with moderate to severe PH&#44; and was correlated with PASP&#44; RAP&#44; RA area&#44; and both RV systolic and diastolic function&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">CS size and morphology have also been investigated in patients with supraventricular tachycardia and connection of a persistent left superior vena cava to the CS&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#8211;19</span></a> Recently&#44; Vatankulu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> reported that the RV myocardial performance index&#44; which represents both systolic and diastolic function&#44; was increased in patients with mitral stenosis and correlated with CS dilatation&#46; In our literature review&#44; we found no studies investigating the relationship between CS diameter and RV diastolic function in patients with PH&#46; However&#44; we determined that CS dilatation was significantly correlated with RV systolic &#40;FAC&#44; Sm wave&#41; and diastolic parameters &#40;E&#47;A ratio&#44; DT&#44; E&#47;Em ratio&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The ASE&#47;ESC guidelines for the echocardiographic assessment of the right heart in adults<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> recommend that RA area should be estimated in patients undergoing assessment of RV or LV dysfunction&#46; Although the RA can be assessed from many different views&#44; quantification of RA size is most commonly performed in A4C view&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> Because of the paucity of standardized RA volume data by 2D echocardiography&#44; routine RA volume measurements are not currently recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> It has been shown that RA area&#44; volume and systolic function increase prior to the development of RV dilatation and systolic dysfunction during chronic pressure overload exposure in PH&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> However&#44; RA volume assessment has not been standardized in the same way as LA volume assessment&#46; In our study&#44; RA area was found to be an independent predictor of a dilated CS rather than RAP&#44; which was indirectly calculated by means of the IVC collapsibility index using echocardiography as in clinical practice&#46; In our view&#44; as RAP can fluctuate over time&#44; RA size may be a better measure of mean RAP and CS dilatation&#46; This may explain why RAP did not remain a significant factor in multivariate regression analysis and suggests that increased RA area and impaired venous drainage secondary to increased PASP may lead to CS dilatation in patients with PH&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0100" class="elsevierStylePara elsevierViewall">This was a case-controlled study with a relatively small number of patients&#46; PH is defined as mean pulmonary artery pressure exceeding 25 mmHg at rest as measured by right heart catheterization &#40;RHC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> However&#44; echocardiography was used in our study to estimate PASP rather than the gold standard of RHC&#59; we could not perform RHC due to ethical concerns&#46; Despite doubts regarding Doppler-derived measurements of PASP&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a> it can provide an estimate of PASP since it is a readily available and reliable method for serial measurements<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> and remains the most effective non-invasive screening tool for the assessment of PH in a clinical setting&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> Additionally&#44; it has been reported that echocardiographic evidence of PH is associated with reduced survival&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">In this study&#44; we determined that mean CS diameter was only increased significantly in patients with moderate to severe PH&#44; and that RA area and PASP were independent predictors of CS diameter in patients with PH&#46; Our data suggest that increased RA area and impaired venous drainage secondary to increased PASP may lead to CS dilatation in patients with PH&#46; Further studies are needed to support these findings&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#245;es"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec541752"
          "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 patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Echocardiographic measurements"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusion"
        ]
        10 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-08-23"
    "fechaAceptado" => "2014-11-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec541751"
          "palabras" => array:4 [
            0 => "Pulmonary hypertension"
            1 => "Coronary sinus"
            2 => "Right atrial area"
            3 => "Pulsed-wave tissue Doppler"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec541752"
          "palabras" => array:4 [
            0 => "Hipertens&#227;o pulmonar"
            1 => "Seio coron&#225;rio"
            2 => "&#193;rea auricular direita"
            3 => "Doppler tecidular onda de pulso"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We investigated the relationship between coronary sinus &#40;CS&#41; diameter and pulmonary artery systolic pressure &#40;PASP&#41; in patients with pulmonary hypertension &#40;PH&#41; and normal left ventricular systolic function&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 155 participants referred for transthoracic echocardiography were included in the study&#46; The study population consisted of 100 patients with chronic PH and 55 control subjects&#46; Patients with PH were divided into two groups according to PASP&#58; those with PASP 36&#8211;45 mmHg&#44; the mild PH group &#40;n&#61;53&#41;&#59; and those with PASP &#62;45 mmHg&#44; the moderate to severe PH group &#40;n&#61;47&#41;&#46; CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula&#58; mean CS&#61;&#40;proximal CS&#43;mid CS&#43;distal CS&#41;&#47;3&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group &#40;1&#46;12&#177;0&#46;2 cm vs&#46; 0&#46;82&#177;0&#46;1 cm and 0&#46;87&#177;0&#46;1 cm&#44; respectively&#59; p&#60;0&#46;001&#41;&#46; It was significantly correlated with right atrial &#40;RA&#41; area &#40;r&#61;0&#46;674&#44; p&#60;0&#46;001&#41;&#44; RA pressure &#40;r&#61;0&#46;458&#44; p&#60;0&#46;001&#41;&#44; PASP &#40;r&#61;0&#46;562&#44; p&#60;0&#46;001&#41;&#44; inferior vena cava diameter &#40;r&#61;0&#46;416&#44; p&#60;0&#46;001&#41;&#44; right ventricular E&#47;A ratio &#40;r&#61;&#8722;0&#46;290&#44; p&#60;0&#46;001&#41;&#44; and E&#47;Em ratio &#40;r&#61;0&#46;235&#44; p&#61;0&#46;004&#41;&#46; RA area &#40;&#946;&#61;0&#46;475&#44; p&#60;0&#46;001&#41; and PASP &#40;&#946;&#61;0&#46;360&#44; p&#61;0&#46;002&#41; were found to be independent predictors of CS diameter&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A dilated CS was associated with moderate to severe pulmonary hypertension&#44; and RA area and PASP were independent predictors of CS diameter&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Os autores analisaram a rela&#231;&#227;o entre o di&#226;metro do seio coron&#225;rio &#40;SC&#41; e a press&#227;o sist&#243;lica arterial pulmonar &#40;PSAP&#41; em doentes com hipertens&#227;o pulmonar &#40;HP&#41; que apresentaram fun&#231;&#245;es sist&#243;licas ventriculares esquerdas normais&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Um total de 155 participantes referidos para ecocardiografia transtor&#225;cica foram inclu&#237;dos no estudo&#46; A popula&#231;&#227;o do estudo &#233; composta por 100 doentes com HP cr&#243;nica e 55 indiv&#237;duos no grupo controlo&#46; Os doentes com HP foram divididos em dois grupos de acordo com a PSAP&#46; Os doentes que tiveram PSAP de 36 a 45 mmHg foram definidos como o grupo de HP ligeiro &#40;n &#61; 53&#41; e aqueles com PSAP &#62; 45 mmHg foram selecionados como o grupo de HP moderada-grave &#40;n &#61; 47&#41;&#46; O di&#226;metro do SC foi medido desde o sulco auriculoventricular posterior na incid&#234;ncia apical quarto c&#226;maras durante a s&#237;stole ventricular de acordo com a f&#243;rmula&#58; media do SC &#61; &#40;SC proximal &#43; SC m&#233;dio &#43; SC distal&#41;&#47;3&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O di&#226;metro m&#233;dio do SC foi significativamente superior no grupo da HP moderada &#8211;grave do que no grupo controlo e no grupo da HP suave &#40;1&#44;12&#177;0&#44;2 cm <span class="elsevierStyleItalic">versus</span> 0&#44;82&#177;0&#44;1 cm e 0&#44;87&#177;0&#44;1 cm&#59; p &#60;0&#44;001&#44; respetivamente&#41;&#46; Verificou-se uma correla&#231;&#227;o&#44; estatisticamente significativa&#44; com a &#225;rea da aur&#237;cula direita &#40;AD&#41; &#40;r &#61; 0&#44;674&#44; p &#60; 0&#44;001&#41;&#44; press&#227;o da AD &#40;r &#61; 0&#44;458&#44; p &#60; 0&#44;001&#41;&#44; PSAP &#40;R &#61; 0&#44;562&#44; p &#60; 0&#44;001&#41;&#44; veia cava inferior &#40;r &#61; 0&#44;416&#44; p &#60; 0&#44;001&#41;&#44; r&#225;cio ventricular direito E&#47;A &#40;r &#61; &#8722;0&#44;290&#44; p &#60; 0&#44;001&#41; e r&#225;cio E&#47;Em &#40;r &#61; 0&#44;235&#44; p &#61; 0&#44;004&#41;&#46; &#193;rea da AD &#40;&#946; &#61; 0&#44;475&#44; p &#60; 0&#44;001&#41; e PSAP &#40;&#946; &#61; 0&#44;360&#44; p &#61; 0&#44;002&#41; foram encontradas como fatores preditores independentes do di&#226;metro do SC&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O SC dilatado foi associado &#224; hipertens&#227;o pulmonar moderada a grave e a &#225;rea da AD e da PSAP foram fatores preditores independentes do di&#226;metro do SC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 677
            "Ancho" => 996
            "Tamanyo" => 80164
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Measurement of right atrial area using the planimetry method from apical 4-chamber view&#46; The green arrow shows this patient&#39;s right atrial area&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 680
            "Ancho" => 996
            "Tamanyo" => 79264
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Measurement of coronary sinus &#40;CS&#41; diameter&#46; Three measurements were obtained at the termination of the CS orifice&#44; 1 cm to its left&#44; and between the orifice and the left side origin&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 763
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Error bar graph of mean coronary sinus diameter in the three groups&#46; CI&#58; confidence interval&#59; CS&#58; coronary sinus&#59; PH&#58; pulmonary hypertension&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; BSA&#58; body surface area&#59; CAD&#58; coronary artery disease&#59; CS&#58; coronary sinus&#59; HTN&#58; hypertension&#59; IVC&#58; inferior vena cava&#59; LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVH&#58; left ventricular hypertrophy&#59; PASP&#58; pulmonary artery systolic pressure&#59; RA&#58; right atrial&#59; RAP&#58; right atrial pressure&#59; RV&#58; right ventricular&#59; TAPSE&#58; tricuspid annular plane systolic excursion&#59; TR&#58; tricuspid regurgitation&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Data presented as n &#40;&#37;&#41; or mean &#177; SD&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;2&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;n&#61;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;n&#61;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> &#40;n&#61;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#177;13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;9&#177;13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;6&#177;14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Female&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;58&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;68&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HTN&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;32&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;44&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;892&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;218&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;275&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Smoker&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;923&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;914&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CAD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;552&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;7&#177;3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;9&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;7&#177;3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;932&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">BSA &#40;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;79&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;81&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;76&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;679&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVEF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;3&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;7&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;8&#177;3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;703&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVH&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;661&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVEDD &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;76&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;78&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;67&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;823&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LA diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;58&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;61&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;64&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;576&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;818&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">E&#47;A ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;93&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;790&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;859&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RA end-systolic area &#40;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;1&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4&#177;3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV free wall thickness &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV basal diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;883&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry  " align="left" valign="top">RV end-diastolic area &#40;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;9&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;8&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RV end-systolic area &#40;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;9&#177;1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;4&#177;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry  " align="left" valign="top">PASP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;8&#177;3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;1&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;9&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3&#177;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&#177;1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&#177;4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IVC diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;75&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CS mean diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;87&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;12&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mild TR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;60&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Moderate TR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;39&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab841628.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Controls&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Mild PH&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Moderate to severe PH&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline demographic and echocardiographic characteristics of the study population&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0010"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Am&#58; myocardial atrial peak velocity&#59; Em&#58; myocardial early peak velocity&#59; Sm&#58; myocardial systolic wave velocity&#46; Other abbreviations as in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Data presented as n &#40;&#37;&#41; or mean &#177; SD&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p &#40;2&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> &#40;n&#61;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> &#40;n&#61;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a> &#40;n&#61;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Systolic function</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RV fractional area change &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;9&#177;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;6&#177;6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;9&#177;12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TAPSE &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&#177;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sm wave &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6&#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Diastolic function</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E wave &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;1&#177;5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;3&#177;7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;3&#177;8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;856&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A wave &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;6&#177;4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;7&#177;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;2&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;591&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;359&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;908&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deceleration time &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">186&#46;8&#177;26&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">192&#46;9&#177;33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">199&#46;3&#177;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;523&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;837&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E&#47;A ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;05&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;90&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;672&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Em wave &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;1&#177;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#177;2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Am wave &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;3&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;956&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;685&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E&#47;Em ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&#177;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&#177;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Controls&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Mild PH&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Moderate to severe PH&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Right ventricular systolic and diastolic function parameters&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Em&#58; myocardial early peak velocity&#59; Sm&#58; myocardial systolic wave velocity&#46; Other abbreviations as in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">LA diameter</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;527&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">LVEDD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">LVEF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;708&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;769&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">RV end-systolic area</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">RV end-diastolic area</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">RV fractional area change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">RA end-systolic area</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;674&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deceleration time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;186&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E&#47;Em ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Association of mean coronary sinus diameter and other parameters&#46;</p>"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2015.05.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	23	4	27
2024 October	78	32	110
2024 September	100	22	122
2024 August	79	26	105
2024 July	71	29	100
2024 June	71	30	101
2024 May	68	28	96
2024 April	51	23	74
2024 March	67	21	88
2024 February	80	22	102
2024 January	83	26	109
2023 December	68	23	91
2023 November	59	22	81
2023 October	66	15	81
2023 September	45	24	69
2023 August	49	17	66
2023 July	61	7	68
2023 June	50	15	65
2023 May	57	27	84
2023 April	47	1	48
2023 March	59	25	84
2023 February	60	27	87
2023 January	63	16	79
2022 December	52	23	75
2022 November	70	26	96
2022 October	66	16	82
2022 September	51	34	85
2022 August	62	48	110
2022 July	63	41	104
2022 June	66	23	89
2022 May	49	35	84
2022 April	54	25	79
2022 March	52	26	78
2022 February	51	24	75
2022 January	49	20	69
2021 December	39	29	68
2021 November	58	31	89
2021 October	66	30	96
2021 September	59	35	94
2021 August	57	26	83
2021 July	56	37	93
2021 June	42	19	61
2021 May	59	27	86
2021 April	109	28	137
2021 March	78	19	97
2021 February	75	6	81
2021 January	39	16	55
2020 December	40	10	50
2020 November	47	11	58
2020 October	44	4	48
2020 September	57	12	69
2020 August	41	9	50
2020 July	51	8	59
2020 June	43	3	46
2020 May	54	15	69
2020 April	56	10	66
2020 March	56	15	71
2020 February	150	23	173
2020 January	65	11	76
2019 December	53	6	59
2019 November	49	6	55
2019 October	34	4	38
2019 September	50	4	54
2019 August	29	9	38
2019 July	33	8	41
2019 June	43	16	59
2019 May	31	3	34
2019 April	24	17	41
2019 March	50	12	62
2019 February	54	12	66
2019 January	46	5	51
2018 December	67	10	77
2018 November	311	16	327
2018 October	667	36	703
2018 September	120	16	136
2018 August	98	11	109
2018 July	43	8	51
2018 June	40	8	48
2018 May	48	6	54
2018 April	44	7	51
2018 March	58	6	64
2018 February	35	1	36
2018 January	50	4	54
2017 December	75	15	90
2017 November	55	8	63
2017 October	51	13	64
2017 September	52	10	62
2017 August	53	17	70
2017 July	26	11	37
2017 June	37	15	52
2017 May	55	4	59
2017 April	52	8	60
2017 March	43	12	55
2017 February	27	6	33
2017 January	40	6	46
2016 December	46	11	57
2016 November	41	4	45
2016 October	43	13	56
2016 September	41	16	57
2016 August	22	3	25
2016 July	16	3	19
2016 June	20	5	25
2016 May	20	5	25
2016 April	24	2	26
2016 March	34	5	39
2016 February	61	15	76
2016 January	29	6	35
2015 December	45	12	57
2015 November	31	5	36
2015 October	40	5	45
2015 September	37	7	44
2015 August	30	10	40
2015 July	16	7	23
2015 June	52	6	58

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