Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure | Revista Portuguesa de Cardiologia (English edition)

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EMD: electromechanical delay." ] ] ] "textoCompleto" => "IntroductionHypertension plays a significant role in the etiology of various cardiovascular diseases. Pulse pressure (PP), defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP), has a strong and independent association with cardiovascular morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0170">1</a>Atrial fibrillation (AF) is the most common sustained arrhythmia, for which the classical risk factors are age, diabetes, obesity, hypertension, left ventricular hypertrophy, coronary artery disease, heart failure and valvular disease.<a class="elsevierStyleCrossRef" href="#bib0175">2</a> Previous studies have indicated that both high blood pressure (BP)<a class="elsevierStyleCrossRef" href="#bib0180">3</a> and elevated PP independently predict development of AF.<a class="elsevierStyleCrossRef" href="#bib0185">4</a> Additionally, increased PP is associated with left atrial (LA) enlargement, which is another known risk factor for AF.<a class="elsevierStyleCrossRef" href="#bib0190">5</a> Although pathophysiologically it has been proposed that increased arterial stiffness can lead to increased left ventricular load by elevating PP, it has been determined that PP elevation is a more important risk factor for AF than increased arterial stiffness.<a class="elsevierStyleCrossRef" href="#bib0195">6</a>Delayed atrial conduction is important in the development in AF via initiation of reentry.<a class="elsevierStyleCrossRef" href="#bib0200">7</a> Atrial electromechanical delay (EMD), defined as the time from the onset of the P wave on the electrocardiogram (ECG) to the onset of the late diastolic wave (A) from the ventricular annulus and atrial walls on tissue Doppler imaging (the PA interval), is one of the indicators of an arrhythmogenic substrate in patients with AF.<a class="elsevierStyleCrossRefs" href="#bib0205">8,9</a>There are few data on the role of delayed atrial conduction in the development of AF in hypertensive patients with increased PP. In this study, we investigated the relationship between PP and atrial EMD, which are both important precursors of AF, in hypertensive patients with no structural cardiac abnormalities.MethodsStudy populationThe study included 284 consecutive patients previously diagnosed with essential hypertension, aged 18-75 years. Detailed physical examinations were performed and medical histories were obtained from all patients. Complete blood count and biochemical analysis together with anthropometric measurements were performed on the same day as the echocardiographic examination. Antihypertensive treatments were recorded.The following patients were not included in the study: those taking antihypertensive drugs causing PR interval prolongation (such as beta-blocking agents, verapamil, and diltiazem) and those with diabetes, structural heart disease (more than mild valvular disease, left ventricular mass index [LVMI] greater than 95 g/m2 in women and 115 g/m2 in men, grade >1 diastolic dysfunction, or LA enlargement [LA volume index (LAVI) >34 ml/m2]), sustained atrial or ventricular arrhythmia, systemic inflammatory disease, hepatic, renal or pulmonary disease, known obstructive sleep apnea, white coat hypertension or poor echogenicity. After these exclusions, 157 patients were enrolled in the study. The study protocol complied with the Helsinki Declaration, and was approved by the local ethics committee. All patients provided informed consent.Blood pressure measurementOffice BP was measured by trained physicians in two study visits, one week apart, using a validated aneroid device with appropriate cuff sizes (Perfect Aneroid, ERKA, Bad Tölz, Germany). BP was measured after at least 5 min rest in a seated position and the measurement was repeated twice at 2-min intervals. The second and third measurements of each series were used and the mean of four measurements at two visits was determined. PP values were calculated by subtracting mean DBP from mean SBP. PP ≥60 mmHg was regarded as elevated and the patients were divided into two groups, normal and elevated PP.<a class="elsevierStyleCrossRef" href="#bib0215">10</a>Transthoracic echocardiographyAll transthoracic echocardiography examinations were performed using a Philips iE33 xMATRIX ultrasound system with a 2.5/3.5 MHz transducer (Philips Electronics, The Netherlands), and were recorded on digital media. The recordings were later analyzed by an experienced echocardiographer who was blinded to the patients included in the study.Left ventricular end-diastolic diameter (LVEDD) and wall thickness measurements were obtained using parasternal long-axis M-mode images. The prolate ellipse method was used to calculate LA volume.<a class="elsevierStyleCrossRef" href="#bib0220">11</a> Apical 4-chamber and parasternal long-axis images were obtained at ventricular end-systole. In apical 4-chamber view, the distance from the mitral annular plane to the posterior wall was defined as D2, and the short-axis dimension orthogonal to D2 was defined as D1. In parasternal long-axis view, the diameter between anterior and posterior walls was recorded as D3. LA volume was calculated by the formula (D1×D2×D3)×0.523. LAVI was determined by dividing LA volume by estimated body surface area. LVMI was calculated as recommended in the current guidelines, using the formula LV mass=0.8{1.04[(LVEDD+posterior wall thickness+septal wall thickness)3-(LVEDD)3]}+0.6.<a class="elsevierStyleCrossRef" href="#bib0225">12</a> Grade I diastolic dysfunction was defined as E/A ratio <0.8, mitral deceleration time >200 ms, septal mitral annular E wave (é) <8 cm/s and mean E/e′ ≤8, on tissue Doppler imaging.<a class="elsevierStyleCrossRef" href="#bib0230">13</a> The PA interval was defined as the time from the onset of the P wave on the surface ECG to the onset of the A wave, which was obtained by placing the tissue Doppler sample volume over the LV lateral mitral annulus, septal mitral annulus and right ventricular tricuspid annulus. PA was calculated three times and the mean was recorded.<a class="elsevierStyleCrossRef" href="#bib0235">14</a> Intra-right atrial conduction time was defined as septal mitral annular PA minus tricuspid annular PA; intra-left atrial conduction time was defined as lateral mitral annular PA minus septal mitral annular PA; and interatrial conduction time was defined as lateral mitral annular PA minus tricuspid annular PA.Twelve-lead electrocardiographyA 12-lead surface ECG was recorded for all patients in the supine position using a Nihon Kohden system (Tokyo, Japan) with a paper speed of 25 mm/s and 10 mm/mV standardization. ECGs were transferred to digital media and measurements were performed manually at a magnification of 400% by two experienced cardiologists who were blinded to the study. P-wave duration was measured from the onset to the offset of the P wave in all 12 leads of the surface ECG. The difference between maximum and minimum P-wave duration was calculated and defined as P-wave dispersion (Pd). The mean Pd values obtained by two investigators were used. Intra-observer and inter-observer coefficients of variation for Pd were 3.7% and 4.8%, respectively.Statistical analysisStatistical analyses were performed using SPSS 22.0 (IBM SPSS Inc., Chicago, IL, USA). Normally distributed continuous variables were expressed as means ± standard deviation, non-normally distributed continuous variables as medians (minimum-maximum), and categorical variables as percentages. The normality of the data was assessed with the Kolmogorov-Smirnov test. Categorical variables were compared with the chi-square test, and continuous variables were compared with either the Mann-Whitney U test or the Student's t test, as appropriate. Correlation analysis was performed using the Pearson test. Age, gender, smoking status, body mass index, serum creatinine, hemoglobin, white blood cell count, cholesterol, LVMI, LAVI, diastolic dysfunction, anti-hypertensive medication, SBP, DBP and PP were tested in univariate linear regression analysis. Multivariate regression analysis including all variables associated in univariate analysis (p<0.2) was used to identify predictors of inter- and intra-atrial EMD. A value of p<0.05 was accepted as statistically significant.ResultsPatients’ baseline characteristics are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Of the 157 patients included in the study, 101 had normal PP and 56 had elevated PP. There were 61 women in the normal PP group and 31 women in the elevated PP group (60% and 55%, respectively). Apart from the difference in SBP, there was no difference between the groups with regard to baseline demographic characteristics and laboratory results. Antihypertensive treatments were similar.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Echocardiographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. LVMI (77.3±13.5 g/m2 vs. 80.9±19.6 g/m2, p=0.180) and LAVI (23.6±4.9 ml/m2 vs. 25.2±6.5 ml/m2, p=0.141) were higher in patients with elevated PP, but without statistical significance. The frequency of grade I diastolic dysfunction was similar in both groups (42% vs. 53%, p=0.242).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Inter-atrial EMD was 33.6±9.2 ms in patients with normal PP, and 41.5±11.3 ms in patients with elevated PP (p<0.001). Intra-left atrial EMD (23.0±8.8 ms vs. 28.2±10.6 ms, p=0.001) and intra-right atrial EMD (10.5±5.8 ms vs. 13.2±4.9 ms, p=0.004) were significantly prolonged in patients with elevated PP (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). P-maximum (108±8 ms vs. 114±9 ms, p<0.001) and Pd (30±13 ms vs. 38±13 ms, p<0.001) were also prolonged in patients with elevated PP.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>According to the correlation analysis, there was a significant positive correlation between PP and inter-atrial EMD (r=0.425, p<0.001), intra-left atrial EMD (r=0.326, p<0.001) and intra-right atrial EMD (r=0.200, p=0.012) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Multivariate linear regression was used to determine the effect of PP on atrial EMD. PP was independently associated with inter-atrial EMD (β=0.379, t=4.088, p<0.001) and intra-left atrial EMD (β=1.473, t=3.931, p<0.001) after controlling for potential confounders. PP lost its significance for intra-right atrial EMD in multivariate linear regression analysis (p=0.261).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionOur results show that atrial EMD and Pd were greater in patients with elevated PP and no significant cardiac structural remodeling. Moreover, PP was found to be independently associated with atrial EMD. This finding suggests that patients with elevated PP may have increased risk of AF before the development of severe structural remodeling.Atrial EMD can easily be detected by transthoracic echocardiography, and when prolonged is an indicator of arrhythmogenic and diseased atrial tissue.<a class="elsevierStyleCrossRef" href="#bib0200">7</a> Prolonged atrial EMD has been reported in various diseases involving electrical and structural remodeling of the atrium, including atrial septal defect,<a class="elsevierStyleCrossRef" href="#bib0240">15</a> mitral stenosis,<a class="elsevierStyleCrossRef" href="#bib0245">16</a> type 2 diabetes<a class="elsevierStyleCrossRef" href="#bib0250">17</a> and some autoimmune diseases.<a class="elsevierStyleCrossRef" href="#bib0255">18</a> It has been proposed that the conduction blockage and increased atrial conduction delay that occur in these diseases due to atrial fibrosis and remodeling could be a trigger and driving force for AF through the development of reentry loops.As is known, increased BP is an important risk factor for AF.<a class="elsevierStyleCrossRef" href="#bib0260">19</a> Office PP has been found to be independently associated with cardiovascular morbidity and mortality and correlates strongly with ambulatory blood pressure monitoring (ABPM).<a class="elsevierStyleCrossRef" href="#bib0265">20</a> Previous studies have reported that office SBP and PP are independent risk factors for AF, while mean BP and DBP are not.<a class="elsevierStyleCrossRef" href="#bib0185">4</a> Okin et al. noted the importance of SBP in new-onset AF.<a class="elsevierStyleCrossRef" href="#bib0270">21</a> However, as a pulsatile component of BP, PP elevation resulting from either increased SBP or decreased DBP is a more powerful predictor of AF development than other BP parameters.<a class="elsevierStyleCrossRef" href="#bib0275">22</a> Although PP is regarded as an indirect indicator of aortic stiffness, according to Roetker et al. the association between AF and PP cannot be explained by aortic stiffness, and they proposed PP as an independent predictor of AF.<a class="elsevierStyleCrossRef" href="#bib0195">6</a> It is not clear how increased PP produces an AF substrate in the atrium. It is thought that acute elevations in PP together with chronic remodeling processes occurring in the left ventricle and left atrium may play a role in new-onset AF by increasing LA wall tension.<a class="elsevierStyleCrossRef" href="#bib0280">23</a> Furthermore, AF development may also be triggered by PP elevation leading to neurohumoral activation<a class="elsevierStyleCrossRef" href="#bib0285">24</a> and cardiovascular inflammation.<a class="elsevierStyleCrossRef" href="#bib0290">25</a> Electrophysiologically, hypertension leads to global atrial conduction disturbances and facilitates AF inducibility.<a class="elsevierStyleCrossRef" href="#bib0295">26</a> In our study, higher intra-left atrial and inter-atrial EMD values and prolonged Pd in patients with elevated PP were indicators of slow atrial conduction. These findings suggest that electrophysiological remodeling in hypertensive patients is more prominent in those with elevated PP. Although an independent predictor of AF on its own, elevated PP is often found together with additional conditions that are known to be closely associated with AF. A higher prevalence of complications such as left ventricular hypertrophy, LA enlargement and diastolic dysfunction in patients with elevated PP will tend to favor the development of an AF substrate.<a class="elsevierStyleCrossRefs" href="#bib0190">5,6,27</a> In our study population, none of the complications of hypertension in the left heart were observed more frequently in patients with elevated PP. Patients with moderate and severe diastolic dysfunction were excluded from our study, based on the assumption that the effect of PP on atrial EMD may be obscured in these patients.<a class="elsevierStyleCrossRef" href="#bib0305">28</a> The mechanism by which PP was a predictor of atrial EMD independently of LAVI, LVMI, SBP and mild diastolic dysfunction on multivariate analysis is not clear; however this finding may be a reflection of increased LA wall tension. Some studies have found that increased atrial natriuretic peptide levels resulting from increased LA wall tension are associated with AF.<a class="elsevierStyleCrossRef" href="#bib0310">29</a> Furthermore, acute elevation in PP may cause an abrupt increase in LA pressure, and can predict recurrence of AF.<a class="elsevierStyleCrossRef" href="#bib0315">30</a> The pathogenesis of the independent arrhythmogenic effect of PP is not fully understood and it is not clear whether setting control of PP as a clinical target would help to decrease the incidence of newly diagnosed AF. Antihypertensive treatments decrease AF frequency by decreasing atrial dilatation and fibrosis and the atrial refractory period.<a class="elsevierStyleCrossRef" href="#bib0320">31</a> Moreover, regression in LA size achieved by antihypertensive treatment decreases new-onset AF attacks.<a class="elsevierStyleCrossRef" href="#bib0325">32</a> Control of PP optimizes control of left intra-atrial pressure in hypertensive patients, and therefore may reduce the frequency of new-onset AF by decreasing tension-related waves originating from the superior pulmonary veins.<a class="elsevierStyleCrossRefs" href="#bib0315">30,33</a> In our study, there was no difference between the two groups with regard to various antihypertensive drugs.Study limitationsOne limitation of our study is the relatively small number of patients. Although the prolate ellipse method used to calculate LAVI has been reported to give relatively low LA volume values, especially in patients with increased anteroposterior diameter, there was no apparent enlargement in this diameter in our patient group.<a class="elsevierStyleCrossRef" href="#bib0220">11</a> Another limitation was the fact that LA wall tension and pressure were not assessed, which could have been relevant to the etiopathogenesis of AF. Assessment of BP by ABPM would also have given additional information and might have helped to diagnose white coat hypertension and masked hypertension. Types of drugs and their dosages might have influenced the results, but this would have been difficult to control for given the large number of antihypertensive agents used and their different dosages.ConclusionIn conclusion, our study showed that elevated PP is associated with higher atrial EMD and Pd in the early stages of hypertension before the development of significant structural remodeling. Elevated PP is a contributor to increased atrial EMD independently of SBP, LAVI, LVMI and mild diastolic dysfunction. These findings may help to understand the greater tendency of patients with elevated PP to develop AF. Further studies are needed to understand atrial electrical remodeling in patients with elevated PP.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres859473" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec853580" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres859472" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec853581" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Blood pressure measurement" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Transthoracic echocardiography" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Twelve-lead electrocardiography" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-30" "fechaAceptado" => "2016-10-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec853580" "palabras" => array:5 [ 0 => "Atrial conduction time" 1 => "Electromechanical delay" 2 => "Pulse pressure" 3 => "Atrial fibrillation" 4 => "Essential hypertension" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec853581" "palabras" => array:5 [ 0 => "Tempo de condução auricular" 1 => "Atraso eletromecânico" 2 => "Pressão do pulso" 3 => "Fibrilhação auricular" 4 => "Hipertensão essencial" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivePulse pressure (PP) is the difference between systolic and diastolic blood pressure, and is an independent predictor of atrial fibrillation (AF). In this study we investigated the relationship between PP and atrial conduction times. MethodsThe study included 157 patients with essential hypertension. PP of 60 mmHg or more was regarded as elevated (n=56). Atrial electromechanical delay (EMD) was assessed with tissue Doppler echocardiography and P-wave dispersion (Pd) was calculated from the electrocardiogram. ResultsLeft atrial volume index (23.6±4.9 ml/m2 vs. 25.2±6.5 ml/m2, p=0.141), left ventricular mass index (77.3±13.5 g/m2 vs. 80.9±19.6 g/m2, p=0.180) and grade I diastolic dysfunction (42% vs. 53%, p=0.242) were similar between groups. Inter-atrial (33.6±9.2 ms vs. 41.5±11.3 ms, p<0.001), intra-left atrial (23.0±8.8 ms vs. 28.2±10.6 ms, p=0.001) and intra-right atrial (10.5±5.8 ms vs. 13.2±4.9 ms, p=0.004) EMD were found to be higher in patients with elevated PP. P-maximum (108±8 ms vs. 114±9 ms, p<0.001) and Pd (30±13 ms vs. 38±13 ms, p<0.001) were also prolonged in patients with elevated PP. Multivariate linear regression analysis revealed that PP was independently associated with inter-atrial EMD (β=0.379, t=4.088, p<0.001). ConclusionThis study showed that elevated PP is associated with prolonged atrial EMD and Pd. Atrial conduction is disturbed in hypertensive patients with elevated PP before the development of significant structural remodeling." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivosA pressão do pulso (PP) é a diferença entre as pressões sistólica e diastólica, e é um preditor independente da fibrilhação auricular. Neste estudo, investigamos a relação entre a PP e os tempos de condução auricular. MétodosO estudo incluiu 157 doentes com hipertensão essencial. Uma PP de 60 mmHg ou superior foi considerada elevada (n=56). O atraso eletromecânico auricular foi avaliado através de ecocardiografia Doppler tecidular e a dispersão da onda P foi calculada através de eletrocardiograma. ResultadosO índice do volume auricular esquerdo (23,6±4,9 mL/m2versus 25,2±6,5 mL/m2, p=0,141), o índice da massa ventricular esquerda (77,3±13,5 g/m2versus 80,9±19,6 g/m2, p=0,180) e a relação da disfunção diastólica grau I (42 versus 53%, p=0,242) foram semelhantes entre os grupos. Um atraso eletromecânico auricular inter (33,6±9,2 ms versus 41,5±11,3 ms, p<0,001), intraesquerdo (23,0±8,8 ms versus 28,2±10,6 ms, p=0,001) e intradireito (10,5±5,8 ms versus 13,2±4,9 ms, p=0,004) foram considerados superiores nos doentes com PP elevada. Uma pressão máxima (108±8 ms versus 114±9 ms, p<0,001) e uma dispersão da onda P (30±13 ms versus 38±13 ms, p<0,001) foram também prolongados nos doentes com PP elevada. Uma análise multivariada de regressão linear revelou que a PP estava independentemente associada ao atraso eletromecânico auricular (β=0,379, t=4,088, p<0,001). ConclusãoEste estudo mostrou que a PP elevada está associada ao prolongamento do atraso eletromecânico auricular e da dispersão da onda P. A condução auricular revela mais alterações nos doentes hipertensos com PP elevada antes do desenvolvimento de remodelagem estrutural significativa." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 883 "Ancho" => 3332 "Tamanyo" => 198713 ] ] "descripcion" => array:1 [ "en" => "Pearson's correlation analysis demonstrating the correlation between pulse pressure and atrial electromechanical delay. EMD: electromechanical delay." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; BMI: body mass index; BSA: body surface area; CCB: calcium channel blocker; DBP: diastolic blood pressure; HDL: high density lipoprotein; LDL: low density lipoprotein; PP: pulse pressure; SBP: systolic blood pressure; WBC: white blood cell count.Data are presented as mean ± standard deviation or median (minimum-maximum). Bold values indicate statistical significance." "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="" 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">PP <60 mmHg (n=101) \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">PP ≥60 mmHg (n=56) \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-with-role" title="table-entry ; entry_with_role_rowhead " 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">50.4±10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.3±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.151 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">61 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.613 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">27.4 (24.3-31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6 (27.1-28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.819 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">1.78±0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.77±0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.700 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.617 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142±11 \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.1±6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.7±5.9 \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></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Medication</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACEI (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.336 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ARB (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.197 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCB (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.554 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diuretic (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.670 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alpha-blocker (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.538 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Laboratory tests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94±0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97±0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.234 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.9 (12.7-13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.0 (12.1-15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.125 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WBC (109/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.488 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasting blood glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (72-96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (67-99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.540 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178 (146-204) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187 (143-213) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.521 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (85-136) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (90-136) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.269 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.6±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.1±7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.692 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">181 (138-221) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">177 (143-203) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.438 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1452727.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the study population." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "é: mitral annular velocity; EDT: mitral E-wave deceleration time; IVRT: isovolumetric relaxation time; IVS: interventricular septum; LA: left atrium; LVEDD: left ventricular end-diastolic diameter; LVMI: left ventricular mass index; PW: posterior wall. Data are presented as mean ± standard deviation or median (minimum-maximum). Bold values indicate statistical significance." "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="" 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">PP <60 mmHg (n=101) \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">PP ≥60 mmHg (n=56) \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDD (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (43-51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (42-52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.971 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ejection fraction (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.8±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.499 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PW thickness (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.2±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.551 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVS thickness (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.178 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVMI (g/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.3±13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.9±19.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.180 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.3±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.0±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.177 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA volume index (ml/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.6±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.2±6.5 \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral E velocity (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.794 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral A velocity (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85±13 \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-with-role" title="table-entry ; entry_with_role_rowhead " 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">1.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8±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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DT (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">191±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">193±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.199 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVRT (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.116 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal é (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.326 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateral é (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.7±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.206 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean é (cm/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.205 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean E/é \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.210 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade I diastolic dysfunction (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.242 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1452726.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Echocardiographic parameters of the two groups." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "PA: time from the onset of the P-wave on surface electrocardiogram to the beginning of the A wave on tissue Doppler imaging; Pd: P-wave dispersion; Pmax: maximum P-wave duration; Pmin: minimum P-wave duration." "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="" 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">PP <60 mmHg (n=101) \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">PP ≥60 mmHg (n=56) \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pmax (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114±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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pmin (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.783 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pd (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38±13 \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA lateral (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64±13 \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA septum (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.683 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA tricuspid (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.066 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA lateral-PA tricuspid<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.6±9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.5±11.3 \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA lateral-PA septum<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.0±8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.2±10.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA septum-PA tricuspid<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1452725.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Inter-atrial electromechanical delay." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Intra-left atrial mechanical delay." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Intra-atrial electromechanical delay. 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Original Article

Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure

Alterações precoces nos tempos de condução auricular nos doentes hipertensos com pressão de pulso elevada

Tolga Çimen

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drtolgacim@hotmail.com

Corresponding author.

, Hamza Sunman, Tolga Han Efe, Ahmet Akyel, Kadriye Yayla, Haluk Furkan Şahan, Murat Bilgin, Lale Dinç Asarcıklı, Ali Nallbani, Mehmet Doğan, Sadık Açıkel, Ekrem Yeter

Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pearson&#39;s correlation analysis demonstrating the correlation between pulse pressure and atrial electromechanical delay&#46; EMD&#58; electromechanical delay&#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">Hypertension plays a significant role in the etiology of various cardiovascular diseases&#46; Pulse pressure &#40;PP&#41;&#44; defined as the difference between systolic blood pressure &#40;SBP&#41; and diastolic blood pressure &#40;DBP&#41;&#44; has a strong and independent association with cardiovascular morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is the most common sustained arrhythmia&#44; for which the classical risk factors are age&#44; diabetes&#44; obesity&#44; hypertension&#44; left ventricular hypertrophy&#44; coronary artery disease&#44; heart failure and valvular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> Previous studies have indicated that both high blood pressure &#40;BP&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a> and elevated PP independently predict development of AF&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> Additionally&#44; increased PP is associated with left atrial &#40;LA&#41; enlargement&#44; which is another known risk factor for AF&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> Although pathophysiologically it has been proposed that increased arterial stiffness can lead to increased left ventricular load by elevating PP&#44; it has been determined that PP elevation is a more important risk factor for AF than increased arterial stiffness&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Delayed atrial conduction is important in the development in AF via initiation of reentry&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> Atrial electromechanical delay &#40;EMD&#41;&#44; defined as the time from the onset of the P wave on the electrocardiogram &#40;ECG&#41; to the onset of the late diastolic wave &#40;A&#41; from the ventricular annulus and atrial walls on tissue Doppler imaging &#40;the PA interval&#41;&#44; is one of the indicators of an arrhythmogenic substrate in patients with AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few data on the role of delayed atrial conduction in the development of AF in hypertensive patients with increased PP&#46; In this study&#44; we investigated the relationship between PP and atrial EMD&#44; which are both important precursors of AF&#44; in hypertensive patients with no structural cardiac abnormalities&#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 population</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study included 284 consecutive patients previously diagnosed with essential hypertension&#44; aged 18-75 years&#46; Detailed physical examinations were performed and medical histories were obtained from all patients&#46; Complete blood count and biochemical analysis together with anthropometric measurements were performed on the same day as the echocardiographic examination&#46; Antihypertensive treatments were recorded&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following patients were not included in the study&#58; those taking antihypertensive drugs causing PR interval prolongation &#40;such as beta-blocking agents&#44; verapamil&#44; and diltiazem&#41; and those with diabetes&#44; structural heart disease &#40;more than mild valvular disease&#44; left ventricular mass index &#91;LVMI&#93; greater than 95 g&#47;m<span class="elsevierStyleSup">2</span> in women and 115 g&#47;m<span class="elsevierStyleSup">2</span> in men&#44; grade &#62;1 diastolic dysfunction&#44; or LA enlargement &#91;LA volume index &#40;LAVI&#41; &#62;34 ml&#47;m<span class="elsevierStyleSup">2</span>&#93;&#41;&#44; sustained atrial or ventricular arrhythmia&#44; systemic inflammatory disease&#44; hepatic&#44; renal or pulmonary disease&#44; known obstructive sleep apnea&#44; white coat hypertension or poor echogenicity&#46; After these exclusions&#44; 157 patients were enrolled in the study&#46; The study protocol complied with the Helsinki Declaration&#44; and was approved by the local ethics committee&#46; All patients provided informed consent&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Blood pressure measurement</span><p id="par0035" class="elsevierStylePara elsevierViewall">Office BP was measured by trained physicians in two study visits&#44; one week apart&#44; using a validated aneroid device with appropriate cuff sizes &#40;Perfect Aneroid&#44; ERKA&#44; Bad T&#246;lz&#44; Germany&#41;&#46; BP was measured after at least 5 min rest in a seated position and the measurement was repeated twice at 2-min intervals&#46; The second and third measurements of each series were used and the mean of four measurements at two visits was determined&#46; PP values were calculated by subtracting mean DBP from mean SBP&#46; PP &#8805;60 mmHg was regarded as elevated and the patients were divided into two groups&#44; normal and elevated PP&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Transthoracic echocardiography</span><p id="par0040" class="elsevierStylePara elsevierViewall">All transthoracic echocardiography examinations were performed using a Philips iE33 xMATRIX ultrasound system with a 2&#46;5&#47;3&#46;5 MHz transducer &#40;Philips Electronics&#44; The Netherlands&#41;&#44; and were recorded on digital media&#46; The recordings were later analyzed by an experienced echocardiographer who was blinded to the patients included in the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Left ventricular end-diastolic diameter &#40;LVEDD&#41; and wall thickness measurements were obtained using parasternal long-axis M-mode images&#46; The prolate ellipse method was used to calculate LA volume&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> Apical 4-chamber and parasternal long-axis images were obtained at ventricular end-systole&#46; In apical 4-chamber view&#44; the distance from the mitral annular plane to the posterior wall was defined as D2&#44; and the short-axis dimension orthogonal to D2 was defined as D1&#46; In parasternal long-axis view&#44; the diameter between anterior and posterior walls was recorded as D3&#46; LA volume was calculated by the formula &#40;D1&#215;D2&#215;D3&#41;&#215;0&#46;523&#46; LAVI was determined by dividing LA volume by estimated body surface area&#46; LVMI was calculated as recommended in the current guidelines&#44; using the formula LV mass&#61;0&#46;8&#123;1&#46;04&#91;&#40;LVEDD&#43;posterior wall thickness&#43;septal wall thickness&#41;<span class="elsevierStyleSup">3</span>-&#40;LVEDD&#41;<span class="elsevierStyleSup">3</span>&#93;&#125;&#43;0&#46;6&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> Grade I diastolic dysfunction was defined as E&#47;A ratio &#60;0&#46;8&#44; mitral deceleration time &#62;200 ms&#44; septal mitral annular E wave &#40;&#233;&#41; &#60;8 cm&#47;s and mean E&#47;e&#8242; &#8804;8&#44; on tissue Doppler imaging&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">13</span></a> The PA interval was defined as the time from the onset of the P wave on the surface ECG to the onset of the A wave&#44; which was obtained by placing the tissue Doppler sample volume over the LV lateral mitral annulus&#44; septal mitral annulus and right ventricular tricuspid annulus&#46; PA was calculated three times and the mean was recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> Intra-right atrial conduction time was defined as septal mitral annular PA minus tricuspid annular PA&#59; intra-left atrial conduction time was defined as lateral mitral annular PA minus septal mitral annular PA&#59; and interatrial conduction time was defined as lateral mitral annular PA minus tricuspid annular PA&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Twelve-lead electrocardiography</span><p id="par0050" class="elsevierStylePara elsevierViewall">A 12-lead surface ECG was recorded for all patients in the supine position using a Nihon Kohden system &#40;Tokyo&#44; Japan&#41; with a paper speed of 25 mm&#47;s and 10 mm&#47;mV standardization&#46; ECGs were transferred to digital media and measurements were performed manually at a magnification of 400&#37; by two experienced cardiologists who were blinded to the study&#46; P-wave duration was measured from the onset to the offset of the P wave in all 12 leads of the surface ECG&#46; The difference between maximum and minimum P-wave duration was calculated and defined as P-wave dispersion &#40;Pd&#41;&#46; The mean Pd values obtained by two investigators were used&#46; Intra-observer and inter-observer coefficients of variation for Pd were 3&#46;7&#37; and 4&#46;8&#37;&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS 22&#46;0 &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Normally distributed continuous variables were expressed as means &#177; standard deviation&#44; non-normally distributed continuous variables as medians &#40;minimum-maximum&#41;&#44; and categorical variables as percentages&#46; The normality of the data was assessed with the Kolmogorov-Smirnov test&#46; Categorical variables were compared with the chi-square test&#44; and continuous variables were compared with either the Mann-Whitney U test or the Student&#39;s t test&#44; as appropriate&#46; Correlation analysis was performed using the Pearson test&#46; Age&#44; gender&#44; smoking status&#44; body mass index&#44; serum creatinine&#44; hemoglobin&#44; white blood cell count&#44; cholesterol&#44; LVMI&#44; LAVI&#44; diastolic dysfunction&#44; anti-hypertensive medication&#44; SBP&#44; DBP and PP were tested in univariate linear regression analysis&#46; Multivariate regression analysis including all variables associated in univariate analysis &#40;p&#60;0&#46;2&#41; was used to identify predictors of inter- and intra-atrial EMD&#46; A value of p&#60;0&#46;05 was accepted as statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients&#8217; baseline characteristics are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the 157 patients included in the study&#44; 101 had normal PP and 56 had elevated PP&#46; There were 61 women in the normal PP group and 31 women in the elevated PP group &#40;60&#37; and 55&#37;&#44; respectively&#41;&#46; Apart from the difference in SBP&#44; there was no difference between the groups with regard to baseline demographic characteristics and laboratory results&#46; Antihypertensive treatments were similar&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Echocardiographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; LVMI &#40;77&#46;3&#177;13&#46;5 g&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 80&#46;9&#177;19&#46;6 g&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;180&#41; and LAVI &#40;23&#46;6&#177;4&#46;9 ml&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 25&#46;2&#177;6&#46;5 ml&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;141&#41; were higher in patients with elevated PP&#44; but without statistical significance&#46; The frequency of grade I diastolic dysfunction was similar in both groups &#40;42&#37; vs&#46; 53&#37;&#44; p&#61;0&#46;242&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Inter-atrial EMD was 33&#46;6&#177;9&#46;2 ms in patients with normal PP&#44; and 41&#46;5&#177;11&#46;3 ms in patients with elevated PP &#40;p&#60;0&#46;001&#41;&#46; Intra-left atrial EMD &#40;23&#46;0&#177;8&#46;8 ms vs&#46; 28&#46;2&#177;10&#46;6 ms&#44; p&#61;0&#46;001&#41; and intra-right atrial EMD &#40;10&#46;5&#177;5&#46;8 ms vs&#46; 13&#46;2&#177;4&#46;9 ms&#44; p&#61;0&#46;004&#41; were significantly prolonged in patients with elevated PP &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; P-maximum &#40;108&#177;8 ms vs&#46; 114&#177;9 ms&#44; p&#60;0&#46;001&#41; and Pd &#40;30&#177;13 ms vs&#46; 38&#177;13 ms&#44; p&#60;0&#46;001&#41; were also prolonged in patients with elevated PP&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">According to the correlation analysis&#44; there was a significant positive correlation between PP and inter-atrial EMD &#40;r&#61;0&#46;425&#44; p&#60;0&#46;001&#41;&#44; intra-left atrial EMD &#40;r&#61;0&#46;326&#44; p&#60;0&#46;001&#41; and intra-right atrial EMD &#40;r&#61;0&#46;200&#44; p&#61;0&#46;012&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Multivariate linear regression was used to determine the effect of PP on atrial EMD&#46; PP was independently associated with inter-atrial EMD &#40;&#946;&#61;0&#46;379&#44; t&#61;4&#46;088&#44; p&#60;0&#46;001&#41; and intra-left atrial EMD &#40;&#946;&#61;1&#46;473&#44; t&#61;3&#46;931&#44; p&#60;0&#46;001&#41; after controlling for potential confounders&#46; PP lost its significance for intra-right atrial EMD in multivariate linear regression analysis &#40;p&#61;0&#46;261&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Our results show that atrial EMD and Pd were greater in patients with elevated PP and no significant cardiac structural remodeling&#46; Moreover&#44; PP was found to be independently associated with atrial EMD&#46; This finding suggests that patients with elevated PP may have increased risk of AF before the development of severe structural remodeling&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Atrial EMD can easily be detected by transthoracic echocardiography&#44; and when prolonged is an indicator of arrhythmogenic and diseased atrial tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> Prolonged atrial EMD has been reported in various diseases involving electrical and structural remodeling of the atrium&#44; including atrial septal defect&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> mitral stenosis&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> type 2 diabetes<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> and some autoimmune diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> It has been proposed that the conduction blockage and increased atrial conduction delay that occur in these diseases due to atrial fibrosis and remodeling could be a trigger and driving force for AF through the development of reentry loops&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As is known&#44; increased BP is an important risk factor for AF&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> Office PP has been found to be independently associated with cardiovascular morbidity and mortality and correlates strongly with ambulatory blood pressure monitoring &#40;ABPM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> Previous studies have reported that office SBP and PP are independent risk factors for AF&#44; while mean BP and DBP are not&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> Okin et al&#46; noted the importance of SBP in new-onset AF&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> However&#44; as a pulsatile component of BP&#44; PP elevation resulting from either increased SBP or decreased DBP is a more powerful predictor of AF development than other BP parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> Although PP is regarded as an indirect indicator of aortic stiffness&#44; according to Roetker et al&#46; the association between AF and PP cannot be explained by aortic stiffness&#44; and they proposed PP as an independent predictor of AF&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> It is not clear how increased PP produces an AF substrate in the atrium&#46; It is thought that acute elevations in PP together with chronic remodeling processes occurring in the left ventricle and left atrium may play a role in new-onset AF by increasing LA wall tension&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> Furthermore&#44; AF development may also be triggered by PP elevation leading to neurohumoral activation<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> and cardiovascular inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> Electrophysiologically&#44; hypertension leads to global atrial conduction disturbances and facilitates AF inducibility&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a> In our study&#44; higher intra-left atrial and inter-atrial EMD values and prolonged Pd in patients with elevated PP were indicators of slow atrial conduction&#46; These findings suggest that electrophysiological remodeling in hypertensive patients is more prominent in those with elevated PP&#46; Although an independent predictor of AF on its own&#44; elevated PP is often found together with additional conditions that are known to be closely associated with AF&#46; A higher prevalence of complications such as left ventricular hypertrophy&#44; LA enlargement and diastolic dysfunction in patients with elevated PP will tend to favor the development of an AF substrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5&#44;6&#44;27</span></a> In our study population&#44; none of the complications of hypertension in the left heart were observed more frequently in patients with elevated PP&#46; Patients with moderate and severe diastolic dysfunction were excluded from our study&#44; based on the assumption that the effect of PP on atrial EMD may be obscured in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> The mechanism by which PP was a predictor of atrial EMD independently of LAVI&#44; LVMI&#44; SBP and mild diastolic dysfunction on multivariate analysis is not clear&#59; however this finding may be a reflection of increased LA wall tension&#46; Some studies have found that increased atrial natriuretic peptide levels resulting from increased LA wall tension are associated with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> Furthermore&#44; acute elevation in PP may cause an abrupt increase in LA pressure&#44; and can predict recurrence of AF&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> The pathogenesis of the independent arrhythmogenic effect of PP is not fully understood and it is not clear whether setting control of PP as a clinical target would help to decrease the incidence of newly diagnosed AF&#46; Antihypertensive treatments decrease AF frequency by decreasing atrial dilatation and fibrosis and the atrial refractory period&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> Moreover&#44; regression in LA size achieved by antihypertensive treatment decreases new-onset AF attacks&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> Control of PP optimizes control of left intra-atrial pressure in hypertensive patients&#44; and therefore may reduce the frequency of new-onset AF by decreasing tension-related waves originating from the superior pulmonary veins&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">30&#44;33</span></a> In our study&#44; there was no difference between the two groups with regard to various antihypertensive drugs&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Study limitations</span><p id="par0095" class="elsevierStylePara elsevierViewall">One limitation of our study is the relatively small number of patients&#46; Although the prolate ellipse method used to calculate LAVI has been reported to give relatively low LA volume values&#44; especially in patients with increased anteroposterior diameter&#44; there was no apparent enlargement in this diameter in our patient group&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> Another limitation was the fact that LA wall tension and pressure were not assessed&#44; which could have been relevant to the etiopathogenesis of AF&#46; Assessment of BP by ABPM would also have given additional information and might have helped to diagnose white coat hypertension and masked hypertension&#46; Types of drugs and their dosages might have influenced the results&#44; but this would have been difficult to control for given the large number of antihypertensive agents used and their different dosages&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study showed that elevated PP is associated with higher atrial EMD and Pd in the early stages of hypertension before the development of significant structural remodeling&#46; Elevated PP is a contributor to increased atrial EMD independently of SBP&#44; LAVI&#44; LVMI and mild diastolic dysfunction&#46; These findings may help to understand the greater tendency of patients with elevated PP to develop AF&#46; Further studies are needed to understand atrial electrical remodeling in patients with elevated PP&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres859473"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
              "titulo" => "Objective"
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            1 => array:2 [
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          "identificador" => "xpalclavsec853580"
          "titulo" => "Keywords"
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          "titulo" => "Resumo"
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          "titulo" => "Introduction"
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          "titulo" => "Methods"
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              "identificador" => "sec0015"
              "titulo" => "Study population"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Blood pressure measurement"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Transthoracic echocardiography"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Twelve-lead electrocardiography"
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              "titulo" => "Statistical analysis"
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          "titulo" => "Discussion"
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          "identificador" => "sec0050"
          "titulo" => "Study limitations"
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          "identificador" => "sec0055"
          "titulo" => "Conclusion"
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          "titulo" => "Ethical disclosures"
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              "identificador" => "sec0065"
              "titulo" => "Protection of human and animal subjects"
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              "identificador" => "sec0070"
              "titulo" => "Confidentiality of data"
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              "identificador" => "sec0075"
              "titulo" => "Right to privacy and informed consent"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-05-30"
    "fechaAceptado" => "2016-10-13"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec853580"
          "palabras" => array:5 [
            0 => "Atrial conduction time"
            1 => "Electromechanical delay"
            2 => "Pulse pressure"
            3 => "Atrial fibrillation"
            4 => "Essential hypertension"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec853581"
          "palabras" => array:5 [
            0 => "Tempo de condu&#231;&#227;o auricular"
            1 => "Atraso eletromec&#226;nico"
            2 => "Press&#227;o do pulso"
            3 => "Fibrilha&#231;&#227;o auricular"
            4 => "Hipertens&#227;o essencial"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulse pressure &#40;PP&#41; is the difference between systolic and diastolic blood pressure&#44; and is an independent predictor of atrial fibrillation &#40;AF&#41;&#46; In this study we investigated the relationship between PP and atrial conduction times&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study included 157 patients with essential hypertension&#46; PP of 60 mmHg or more was regarded as elevated &#40;n&#61;56&#41;&#46; Atrial electromechanical delay &#40;EMD&#41; was assessed with tissue Doppler echocardiography and P-wave dispersion &#40;Pd&#41; was calculated from the electrocardiogram&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Left atrial volume index &#40;23&#46;6&#177;4&#46;9 ml&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 25&#46;2&#177;6&#46;5 ml&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;141&#41;&#44; left ventricular mass index &#40;77&#46;3&#177;13&#46;5 g&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 80&#46;9&#177;19&#46;6 g&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;180&#41; and grade I diastolic dysfunction &#40;42&#37; vs&#46; 53&#37;&#44; p&#61;0&#46;242&#41; were similar between groups&#46; Inter-atrial &#40;33&#46;6&#177;9&#46;2 ms vs&#46; 41&#46;5&#177;11&#46;3 ms&#44; p&#60;0&#46;001&#41;&#44; intra-left atrial &#40;23&#46;0&#177;8&#46;8 ms vs&#46; 28&#46;2&#177;10&#46;6 ms&#44; p&#61;0&#46;001&#41; and intra-right atrial &#40;10&#46;5&#177;5&#46;8 ms vs&#46; 13&#46;2&#177;4&#46;9 ms&#44; p&#61;0&#46;004&#41; EMD were found to be higher in patients with elevated PP&#46; P-maximum &#40;108&#177;8 ms vs&#46; 114&#177;9 ms&#44; p&#60;0&#46;001&#41; and Pd &#40;30&#177;13 ms vs&#46; 38&#177;13 ms&#44; p&#60;0&#46;001&#41; were also prolonged in patients with elevated PP&#46; Multivariate linear regression analysis revealed that PP was independently associated with inter-atrial EMD &#40;&#946;&#61;0&#46;379&#44; t&#61;4&#46;088&#44; p&#60;0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study showed that elevated PP is associated with prolonged atrial EMD and Pd&#46; Atrial conduction is disturbed in hypertensive patients with elevated PP before the development of significant structural remodeling&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A press&#227;o do pulso &#40;PP&#41; &#233; a diferen&#231;a entre as press&#245;es sist&#243;lica e diast&#243;lica&#44; e &#233; um preditor independente da fibrilha&#231;&#227;o auricular&#46; Neste estudo&#44; investigamos a rela&#231;&#227;o entre a PP e os tempos de condu&#231;&#227;o auricular&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O estudo incluiu 157 doentes com hipertens&#227;o essencial&#46; Uma PP de 60 mmHg ou superior foi considerada elevada &#40;n&#61;56&#41;&#46; O atraso eletromec&#226;nico auricular foi avaliado atrav&#233;s de ecocardiografia Doppler tecidular e a dispers&#227;o da onda P foi calculada atrav&#233;s de eletrocardiograma&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O &#237;ndice do volume auricular esquerdo &#40;23&#44;6&#177;4&#44;9 mL&#47;m<span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">versus</span> 25&#44;2&#177;6&#44;5 mL&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#44;141&#41;&#44; o &#237;ndice da massa ventricular esquerda &#40;77&#44;3&#177;13&#44;5 g&#47;m<span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">versus</span> 80&#44;9&#177;19&#44;6 g&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#44;180&#41; e a rela&#231;&#227;o da disfun&#231;&#227;o diast&#243;lica grau <span class="elsevierStyleSmallCaps">I</span> &#40;42 <span class="elsevierStyleItalic">versus</span> 53&#37;&#44; p&#61;0&#44;242&#41; foram semelhantes entre os grupos&#46; Um atraso eletromec&#226;nico auricular inter &#40;33&#44;6&#177;9&#44;2 ms <span class="elsevierStyleItalic">versus</span> 41&#44;5&#177;11&#44;3 ms&#44; p&#60;0&#44;001&#41;&#44; intraesquerdo &#40;23&#44;0&#177;8&#44;8 ms <span class="elsevierStyleItalic">versus</span> 28&#44;2&#177;10&#44;6 ms&#44; p&#61;0&#44;001&#41; e intradireito &#40;10&#44;5&#177;5&#44;8 ms <span class="elsevierStyleItalic">versus</span> 13&#44;2&#177;4&#44;9 ms&#44; p&#61;0&#44;004&#41; foram considerados superiores nos doentes com PP elevada&#46; Uma press&#227;o m&#225;xima &#40;108&#177;8 ms <span class="elsevierStyleItalic">versus</span> 114&#177;9 ms&#44; p&#60;0&#44;001&#41; e uma dispers&#227;o da onda P &#40;30&#177;13 ms <span class="elsevierStyleItalic">versus</span> 38&#177;13 ms&#44; p&#60;0&#44;001&#41; foram tamb&#233;m prolongados nos doentes com PP elevada&#46; Uma an&#225;lise multivariada de regress&#227;o linear revelou que a PP estava independentemente associada ao atraso eletromec&#226;nico auricular &#40;&#946;&#61;0&#44;379&#44; t&#61;4&#44;088&#44; p&#60;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudo mostrou que a PP elevada est&#225; associada ao prolongamento do atraso eletromec&#226;nico auricular e da dispers&#227;o da onda P&#46; A condu&#231;&#227;o auricular revela mais altera&#231;&#245;es nos doentes hipertensos com PP elevada antes do desenvolvimento de remodelagem estrutural significativa&#46;</p></span>"
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            "titulo" => "Resultados"
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            "titulo" => "Conclus&#227;o"
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pearson&#39;s correlation analysis demonstrating the correlation between pulse pressure and atrial electromechanical delay&#46; EMD&#58; electromechanical delay&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ACEI&#58; angiotensin converting enzyme inhibitor&#59; ARB&#58; angiotensin receptor blocker&#59; BMI&#58; body mass index&#59; BSA&#58; body surface area&#59; CCB&#58; calcium channel blocker&#59; DBP&#58; diastolic blood pressure&#59; HDL&#58; high density lipoprotein&#59; LDL&#58; low density lipoprotein&#59; PP&#58; pulse pressure&#59; SBP&#58; systolic blood pressure&#59; WBC&#58; white blood cell count&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Data are presented as mean &#177; standard deviation or median &#40;minimum-maximum&#41;&#46; Bold values indicate statistical significance&#46;</p>"
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                  <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="" 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">PP &#60;60 mmHg &#40;n&#61;101&#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">PP &#8805;60 mmHg &#40;n&#61;56&#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">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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;4&#177;10&#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">53&#46;3&#177;13&#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;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;55&#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;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;4 &#40;24&#46;3-31&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6 &#40;27&#46;1-28&#46;0&#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;819&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BSA &#40;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&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;78&#177;0&#46;12&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;77&#177;0&#46;15&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;700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoking &#40;&#37;&#41;</span>&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;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;39&#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;617&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SBP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#177;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DBP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#177;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#177;11&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;630&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PP &#40;mmHg&#41;</span>&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;1&#177;6&#46;0&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;7&#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"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Medication</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACEI &#40;n&#44; &#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">28 &#40;27&#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;19&#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;336&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ARB &#40;n&#44; &#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">25 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;35&#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;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CCB &#40;n&#44; &#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">21 &#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">14 &#40;25&#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;554&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretic &#40;n&#44; &#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">20 &#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">9 &#40;16&#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;670&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alpha-blocker &#40;n&#44; &#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">2 &#40;2&#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 &#40;0&#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;538&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory tests</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine &#40;mg&#47;dl&#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;94&#177;0&#46;15&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;97&#177;0&#46;14&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;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin &#40;g&#47;dl&#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;9 &#40;12&#46;7-13&#46;9&#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;0 &#40;12&#46;1-15&#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;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WBC &#40;10<span class="elsevierStyleSup">9</span>&#47;l&#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;0&#177;0&#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">8&#46;1&#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">0&#46;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fasting blood glucose &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;72-96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;67-99&#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;540&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total cholesterol &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">178 &#40;146-204&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">187 &#40;143-213&#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;521&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LDL cholesterol &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 &#40;85-136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;90-136&#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;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HDL cholesterol &#40;mg&#47;dl&#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&#46;6&#177;7&#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">44&#46;1&#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">0&#46;692&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Triglycerides &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">181 &#40;138-221&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177 &#40;143-203&#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;438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#233;&#58; mitral annular velocity&#59; EDT&#58; mitral E-wave deceleration time&#59; IVRT&#58; isovolumetric relaxation time&#59; IVS&#58; interventricular septum&#59; LA&#58; left atrium&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVMI&#58; left ventricular mass index&#59; PW&#58; posterior wall&#46; Data are presented as mean &#177; standard deviation or median &#40;minimum-maximum&#41;&#46; Bold values indicate statistical significance&#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="" 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">PP &#60;60 mmHg &#40;n&#61;101&#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">PP &#8805;60 mmHg &#40;n&#61;56&#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">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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDD &#40;mm&#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 &#40;43-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;42-52&#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;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ejection fraction &#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;8&#177;2&#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">62&#46;5&#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">0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PW thickness &#40;mm&#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&#46;2&#177;1&#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">9&#46;4&#177;1&#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;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVS thickness &#40;mm&#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&#46;4&#177;1&#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">9&#46;7&#177;1&#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;178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVMI &#40;g&#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">77&#46;3&#177;13&#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">80&#46;9&#177;19&#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;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;3&#177;3&#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">35&#46;0&#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">0&#46;177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA volume index &#40;ml&#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">23&#46;6&#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">25&#46;2&#177;6&#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;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral E velocity &#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">74&#177;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#177;13&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;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral A velocity &#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">73&#177;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#177;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">1&#46;0&#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;8&#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"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DT &#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">191&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">193&#177;10&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;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVRT &#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">79&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#177;10&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;116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal &#233; &#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">8&#46;0&#177;1&#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">7&#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">0&#46;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateral &#233; &#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">11&#46;7&#177;2&#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">11&#46;1&#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;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean &#233; &#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">9&#46;8&#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">9&#46;4&#177;2&#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;205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean E&#47;&#233;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#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">8&#46;1&#177;2&#46;0&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;210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade I diastolic dysfunction &#40;n&#44; &#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">43 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;53&#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;242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">PA&#58; time from the onset of the P-wave on surface electrocardiogram to the beginning of the A wave on tissue Doppler imaging&#59; Pd&#58; P-wave dispersion&#59; Pmax&#58; maximum P-wave duration&#59; Pmin&#58; minimum P-wave duration&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">77&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#177;10&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;783&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">38&#177;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">58&#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">64&#177;13&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA septum &#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">35&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#177;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;683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA tricuspid &#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">24&#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">22&#177;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;066&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">33&#46;6&#177;9&#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">41&#46;5&#177;11&#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"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA lateral-PA septum<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#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">23&#46;0&#177;8&#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">28&#46;2&#177;10&#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"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA septum-PA tricuspid<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> &#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">10&#46;5&#177;5&#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">13&#46;2&#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"><span class="elsevierStyleBold">0&#46;004</span>&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="npar0015">Intra-atrial electromechanical delay&#46;</p> <p class="elsevierStyleNotepara" id="npar0020">Bold values indicate statistical significance&#46;</p>"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison of electrocardiographic and tissue Doppler echocardiographic findings&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:33 [
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              "identificador" => "bib0170"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relation between pulse pressure and cardiovascular mortality in 12&#44;763 middle-aged men from various parts of the world&#58; a 25-year follow-up of the seven countries study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Panagiotakos"
                            1 => "D&#46; Kromhout"
                            2 => "A&#46; Menotti"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinte.165.18.2142"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2005"
                        "volumen" => "165"
                        "paginaInicial" => "2142"
                        "paginaFinal" => "2147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16217005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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              "identificador" => "bib0175"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Independent risk factors for atrial fibrillation in a population-based cohort&#46; The Framingham Heart Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;J&#46; Benjamin"
                            1 => "D&#46; Levy"
                            2 => "S&#46;M&#46; Vaziri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1994"
                        "volumen" => "271"
                        "paginaInicial" => "840"
                        "paginaFinal" => "844"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8114238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of and risk factors for atrial fibrillation in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;M&#46; Psaty"
                            1 => "T&#46;A&#46; Manolio"
                            2 => "L&#46;H&#46; Kuller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1997"
                        "volumen" => "96"
                        "paginaInicial" => "2455"
                        "paginaFinal" => "2461"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9337224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulse pressure and risk of new-onset atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;F&#46; Mitchell"
                            1 => "R&#46;S&#46; Vasan"
                            2 => "M&#46;J&#46; Keyes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.297.7.709"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2016.10.022

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	6	12
2024 October	29	32	61
2024 September	27	26	53
2024 August	30	20	50
2024 July	28	26	54
2024 June	30	27	57
2024 May	34	15	49
2024 April	31	20	51
2024 March	20	15	35
2024 February	26	22	48
2024 January	21	19	40
2023 December	23	19	42
2023 November	25	21	46
2023 October	20	50	70
2023 September	16	16	32
2023 August	20	14	34
2023 July	18	4	22
2023 June	23	14	37
2023 May	31	20	51
2023 April	33	6	39
2023 March	62	22	84
2023 February	44	12	56
2023 January	19	21	40
2022 December	42	25	67
2022 November	55	23	78
2022 October	31	18	49
2022 September	20	21	41
2022 August	19	28	47
2022 July	28	32	60
2022 June	17	17	34
2022 May	18	27	45
2022 April	25	20	45
2022 March	26	36	62
2022 February	19	29	48
2022 January	19	19	38
2021 December	20	33	53
2021 November	32	28	60
2021 October	46	47	93
2021 September	32	24	56
2021 August	46	29	75
2021 July	19	18	37
2021 June	15	18	33
2021 May	34	38	72
2021 April	43	33	76
2021 March	71	17	88
2021 February	54	18	72
2021 January	20	6	26
2020 December	39	5	44
2020 November	17	13	30
2020 October	18	10	28
2020 September	47	7	54
2020 August	36	10	46
2020 July	38	3	41
2020 June	32	8	40
2020 May	37	6	43
2020 April	31	13	44
2020 March	38	9	47
2020 February	55	51	106
2020 January	32	6	38
2019 December	25	4	29
2019 November	40	11	51
2019 October	37	4	41
2019 September	39	6	45
2019 August	23	4	27
2019 July	29	7	36
2019 June	27	14	41
2019 May	37	13	50
2019 April	18	18	36
2019 March	28	6	34
2019 February	32	9	41
2019 January	36	7	43
2018 December	80	9	89
2018 November	243	12	255
2018 October	675	7	682
2018 September	131	13	144
2018 August	96	8	104
2018 July	35	10	45
2018 June	53	5	58
2018 May	57	13	70
2018 April	157	8	165
2018 March	64	16	80
2018 February	18	4	22
2018 January	22	7	29
2017 December	37	15	52
2017 November	30	13	43
2017 October	29	14	43
2017 September	25	10	35
2017 August	46	19	65
2017 July	53	18	71

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