What happens to non-responders in cardiac resynchronization therapy? | Revista Portuguesa de Cardiologia (English edition)

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "885" "paginaFinal" => "892" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Rio, Mário Martins Oliveira, Pedro Silva Cunha, Manuel Nogueira da Silva, Luísa Moura Branco, Ana Galrinho, Rui Soares, Joana Feliciano, Ricardo Pimenta, Rui Cruz Ferreira" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Pedro" "apellidos" => "Rio" "email" => array:1 [ 0 => "pedrosantosrio@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mário Martins" "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "Pedro Silva" "apellidos" => "Cunha" ] 3 => array:2 [ "nombre" => "Manuel Nogueira" "apellidos" => "da Silva" ] 4 => array:2 [ "nombre" => "Luísa Moura" "apellidos" => "Branco" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Galrinho" ] 6 => array:2 [ "nombre" => "Rui" "apellidos" => "Soares" ] 7 => array:2 [ "nombre" => "Joana" "apellidos" => "Feliciano" ] 8 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Pimenta" ] 9 => array:2 [ "nombre" => "Rui Cruz" "apellidos" => "Ferreira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O que acontece aos não respondedores na terapia de ressincronização cardíaca?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2396 "Ancho" => 1497 "Tamanyo" => 200701 ] ] "descripcion" => array:1 [ "en" => "Kaplan-Meier curves of all-cause mortality and hospitalizations due to heart failure. (A) The probability of all-cause mortality differed significantly between clinical responders and non-responders; (B) the probability of all-cause mortality and hospitalizations due to heart failure differed significantly between clinical responders and non-responders." ] ] ] "textoCompleto" => "IntroductionCardiac resynchronization therapy (CRT) is recommended by current guidelines for symptomatic heart failure (HF) with left ventricular ejection fraction (LVEF) ≤35% and prolonged QRS interval.<a class="elsevierStyleCrossRefs" href="#bib0210">1,2</a> CRT is effective in improving HF symptoms, exercise capacity, quality of life and cardiac function, as well as reducing HF hospitalizations and death.<a class="elsevierStyleCrossRefs" href="#bib0220">3–8</a> Trials have assessed the efficacy of CRT by means of improvement in clinical status and/or reduction in left ventricular end-systolic volume (LVESV) at mid-term follow-up.<a class="elsevierStyleCrossRefs" href="#bib0250">9–12</a> Clinical and echocardiographic responses to CRT may not coincide, but left ventricular reverse remodeling (LVRR) is considered a powerful indicator of clinical outcomes.<a class="elsevierStyleCrossRefs" href="#bib0270">13–15</a> Up to 40% of patients will not experience significant reduction in left ventricular chamber size and are defined as CRT non-responders.<a class="elsevierStyleCrossRef" href="#bib0285">16</a> Although this population has a poor prognosis, little is known about the factors that influence their outcomes. The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population.MethodsThis was a single-center study of patients who underwent successful CRT defibrillator device implantation between 2004 and 2012, a total of 178 consecutive CRT recipients. Patient data were prospectively collected in our cardiology department's information system and analyzed retrospectively. Patients were selected for CRT if they met currently recommended criteria: (1) LVEF ≤35%; (2) symptoms of HF, defined as New York Heart Association (NYHA) class II-IV despite optimal medical therapy; and (3) QRS duration ≥120 ms. Patients were classified as ischemic in the presence of significant coronary artery disease (>50% stenosis of two or more epicardial vessels or the left main, or >50% stenosis of the proximal left anterior descending coronary artery on coronary angiography, and/or a history of previous myocardial infarction or myocardial revascularization). All other patients were classified as non-ischemic. Leads were placed transvenously, via the subclavian and cephalic route, using fluoroscopy to visualize their progression and location. The right ventricular lead was positioned in the apex or mid septum. The left ventricular lead was placed with an over-the-wire system in a posterolateral or lateral tributary vein of the coronary sinus depending on ability to cannulate the veins, pacing threshold, or diaphragmatic stimulation. The standard settings included an atrioventricular (AV) delay of 100 ms (sensed) and 130 ms (paced), with DDD or DDDR mode and standard lower (50 beats/min) and upper (120-130 beats/min) pacing rates. Extensive demographic and clinical data, including mortality, NYHA class and hospitalization for worsening HF were collected from medical records. Clinical response to CRT was defined as a sustained improvement of ≥1 NYHA functional class at six-month follow-up. Transthoracic two-dimensional echocardiographic information was assessed at baseline and six months after CRT device implantation. LVRR was defined as an increase of ≥10% in LVEF over baseline combined with ≥15% reduction in left ventricular end-systolic diameter (LVESD). Cardiac structure and function were assessed using a commercially available ultrasound system (Vivid-7 and Vivid-E9; GE Vingmed Ultrasound, Horten, Norway) equipped with a 3.5-MHz transducer. LVESD, left ventricular end-diastolic diameter (LVEDD) and LVEF were determined according to standard techniques and digitally stored for offline analysis in cine-loop format. Echocardiographic CRT optimization was performed if patients presented AV and/or interventricular (VV) dyssynchrony.<a class="elsevierStyleCrossRef" href="#bib0290">17</a> Optimization was based on the iterative method, analyzing changes in left ventricular inflow and outflow, while AV and/or VV delays were changed in 10- or 20-ms steps.Follow-up data were obtained by review of medical records, outpatient clinic visits, and telephone contact. Ethics committee and hospital permission were obtained from the appropriate local authorities.Statistical analysisData are expressed as mean ± standard deviation for continuous variables and as frequencies and percentages for categorical variables. Data distribution was tested for normality using the Kolmogorov-Smirnov or Shapiro-Wilk test as appropriate. Missing patient-level covariates were assumed to be missing and no imputation was performed. Comparisons of baseline characteristics and outcomes were performed using the chi-square test or Fisher's exact test, as appropriate, for categorical variables and the Student's t test or the Mann-Whitney test for continuous variables. Cumulative event rates after CRT device implantation were calculated using the Kaplan-Meier method and the population without LVRR was classified according to clinical response. Log-rank tests for time-to-event data with respect to all-cause mortality were used for statistical comparison between the patient groups. Multivariate Cox proportional hazards models were constructed with backward selection to identify independent predictors of all-cause mortality. All significant univariate clinical and echocardiographic predictors at baseline and hospitalizations for HF during follow-up were entered in the multivariate model as covariates. All statistical tests were two-sided, and a p-value <0.05 was considered significant. SPSS version 21 software (IBM SPSS Inc., Chicago, IL) was used for computation.ResultsBaseline patient characteristicsThe study population consisted of 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male). Baseline patient characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Sixty-nine patients (39%) failed to show an increase of ≥10% in LVEF and ≥15% reduction in LVESD at six-month follow-up (non-LVRR group). The majority of the cohort (65%) had non-ischemic cardiomyopathy.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Regarding differences between the groups, patients without LVRR tended to be male (83% vs. 61% p=0.003), to have ischemic cardiomyopathy (49% vs. 26%, p=0.002) and to show more severe baseline HF (NYHA ≥III 83% vs. 97%, p=0.01). Also, no LVRR after CRT was associated with smoking (47% vs. 25%, p=0.004), lower body mass index (BMI) (26 vs. 28 kg/m2, p=0.042), previous heart surgery (30% vs. 13%, p=0.006), renal dysfunction (46% vs. 27%, p=0.017), higher LVEDD (77 vs. 72 mm, p=0.003) and LVESD (63 vs. 51 mm p<0.001), and reduced LVEF (24% vs. 26%, p=0.037). On the other hand, CRT response was associated with sinus rhythm (73% vs. 42%, p<0.001) and with left bundle branch block (LBBB) (89% vs. 72%, p=0.007).Clinical outcomes in the overall populationDuring a mean follow-up of 56±21 months, 47 (26%) patients died, 21 (45%) due to cardiac causes, 45 (25%) patients were hospitalized due to HF, and 70 (39%) patients died or were hospitalized due to HF.Five-year overall mortality was 39.2%, two-year mortality was 12.6% and one-year mortality was 6.7%. Annual mortality was 7.8% overall. The group with no LVRR showed higher mortality (36% vs. 20%, p=0.023), with more deaths of cardiac cause (23% vs. 5%, p=0.001), and higher rates of hospitalizations due to HF (48% vs. 11%, p<0.001). Clinical response was found to be greater in the LVRR group (88% vs. 55%, p<0.001).Patients without left ventricular reverse remodelingThere were thirty-eight patients (55%) with an improvement of ≥1 NYHA functional class (clinical response to CRT) among the 69 patients without LVRR. Mean NYHA class improved from 2.86±0.46 at implantation to 2.19±0.71 at six-month follow-up (p<0.001, 95% confidence interval [CI], 0.50-0.83). No difference was observed between ischemic and nonischemic cardiomyopathy (p=0.81). Comparison of clinical and echocardiographic data between the two groups (clinical responders vs. non-responders among patients without LVRR) at six-month follow-up are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. There were no differences between the groups in age, gender, baseline NYHA class, BMI, history of diabetes or smoking, atrial fibrillation, renal dysfunction, previous heart surgery, prevalence of LBBB, QRS duration, left ventricular dimensions or systolic function, baseline mitral regurgitation or echocardiographic CRT optimization during follow-up. Twenty-five (36%) patients died, with higher mortality in the non-responders (58% vs. 18%, p=0.001). Thirty-three patients (48%) were hospitalized due to HF (58% vs. 40%, p=0.151) and 24 patients (35%) received appropriate therapies for ventricular tachyarrhythmias (26% vs. 46%, p=0.126).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Clinical response, mortality and hospitalizations due to heart failureNon-responders to CRT among patients without LVRR was significantly associated with all-cause mortality, cardiac death and the combined endpoint (all-cause mortality and hospitalization due to HF). When the population was classified according to clinical response to CRT, a cumulative 3%, 4%, and 10% of the patients with improvement of ≥1 NYHA functional class died at 12-, 24-, and 36-month follow-up, respectively. In contrast, 10%, 29%, and 52% of the patients without improvement of ≥1 NYHA functional class died during the same period, respectively (log-rank p<0.001, <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Also, a cumulative 11%, 18%, and 38% of the patients with improvement of ≥1 NYHA functional class had the combined endpoint by 12-, 24-, and 36-month follow-up, respectively, and 32%, 54%, and 67% of the patients without improvement of ≥1 NYHA functional class had the combined endpoint during the same period (log-rank p=0.002, <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>To determine whether clinical response in patients without LVRR was an independent predictor of all-cause mortality during follow-up, univariate predictors with a p-value <0.05 were entered into a Cox proportional hazards model as covariates (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). On multivariate analysis, clinical response (hazard ratio [HR]: 0.120; 95% CI: 0.039-0.366; p<0.001) was independently associated with better survival. Reduced LVEF at baseline (HR: 4.768; 95% CI: 1.487-15.293; p=0.009), significant mitral regurgitation (grade >2+) post-CRT (HR: 2.863; 95% CI: 1.139-7.196; p=0.025) and hospitalization due to HF within 12 months of follow-up (HR: 2.459; 95% CI: 1.030-5.870; p=0.043) were associated with higher all-cause mortality.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>As expected, the main cause of mortality was cardiac death (16 out of 25 patients). Interestingly, non-responders died more frequently for cardiovascular reasons compared with responders, although this was not statistically significant (13 [72%] vs. 3 [43%], p=0.205).DiscussionThe major findings of the present study, which focused on the prognostic impact of clinical response to CRT in patients without LVRR six months after CRT, are: first, the majority of patients (61%) presented evidence of LVRR; second, the overall clinical response rate was 75%; third, patients with LVRR had higher survival rates and less hospitalizations due to HF; fourth, among patients without LVRR, 55% presented long-term improvement of ≥1 NYHA functional class; fifth, clinical response was the strongest independent predictor of survival in patients without LVRR.Several studies have confirmed the favorable impact on mortality and morbidity of CRT in mid- to long-term follow-up.<a class="elsevierStyleCrossRefs" href="#bib0235">6–12</a> In our cohort, patients with LVRR showed better clinical outcomes, with higher survival rates (80% vs. 64%, p=0.023) and less hospitalizations due to HF (11% vs. 48%, p<0.001). This survival benefit may be related to the occurrence and extent of LVRR in mid-term follow-up, rather than to improvement in NYHA functional class, according to other authors.<a class="elsevierStyleCrossRefs" href="#bib0265">12–16,18–20</a> Results of the REVERSE, MADIT-CRT, and RAFT trials showed that reduction in HF readmissions and improvement in long-term survival appear to be related to LVRR and improvement of left ventricular performance rather than improvements in NYHA functional class, since the patients included were asymptomatic or only mildly symptomatic.<a class="elsevierStyleCrossRefs" href="#bib0265">12,18,19</a> Yu et al.<a class="elsevierStyleCrossRef" href="#bib0270">13</a> showed in 141 HF patients that reductions of ≥10% in LVESV were independently associated with mid-term outcome after CRT and that improvement in clinical parameters was not predictive of long-term survival. In a retrospective and non-randomized study, Bertini et al.<a class="elsevierStyleCrossRef" href="#bib0305">20</a> concluded that reduction in LVESV in mid-term follow-up was a better predictor of long-term survival than improvement in clinical status.According to these data, LVRR should be a more suitable surrogate to assess the efficacy of CRT than subjective clinical parameters. Unfortunately, there are a significant proportion of non-responders to CRT, ranging between 17 and 46%, depending on the criteria used.<a class="elsevierStyleCrossRef" href="#bib0310">21</a> In our study, 39% of patients did not present LVRR. The factors mainly identified as contributors to lack of response to CRT are ischemic etiology, shorter QRS duration and less baseline mechanical dyssynchrony.<a class="elsevierStyleCrossRefs" href="#bib0315">22–24</a> We also found that non-ischemic cardiomyopathy (74% vs. 51%, p=0.002) and LBBB (89% vs. 72%, p=0.007) were associated with LVRR. QRS duration was not found to be statistically associated with LVRR, probably due to the size of our study population. Female gender was associated with LVRR (39% vs. 17%, p=0.003), in agreement with previous studies.<a class="elsevierStyleCrossRefs" href="#bib0330">25,26</a>In the present study, 75% of patients referred for CRT presented a clinical response in long-term follow-up. This higher rate of clinical response compared to LVRR is in line with previous studies, in which clinical responders range between 61% and 77%,<a class="elsevierStyleCrossRefs" href="#bib0320">23,27–29</a> with a mean of 66.9%.<a class="elsevierStyleCrossRef" href="#bib0355">30</a> Although improvement in NYHA functional class and LVRR are connected, the concordance between the two response types is not perfect.<a class="elsevierStyleCrossRef" href="#bib0325">24</a> In the present study, 28% of patients (38 out of 134) with clinical improvement did not have LVRR. Previous studies found similar results, with a rate of disagreement of around 28%.<a class="elsevierStyleCrossRefs" href="#bib0330">25,29–32</a> The follow-up profile in the presence of clinical improvement without LVRR is not well known. It has been questioned whether this change is due to a placebo effect or should also be considered a positive response to CRT. Patients with improvement of ≥1 NYHA class among those without LVRR at six months after CRT showed lower all-cause mortality (18% vs. 58%, p=0.001). Also, on multivariate analysis, clinical response was independently associated with better survival (HR: 0.120, 95% CI: 0.039-0.366, p<0.001).These conflicting findings, which contrast with previously reported results, should be interpreted with caution because of the retrospective nature of the analysis and the size of the study population. Despite this, our results show some similarities with published data. In a study of 174 HF patients, Kronborg et al.<a class="elsevierStyleCrossRef" href="#bib0370">33</a> found that clinical response to CRT was an independent predictor of mortality in very long-term follow-up (HR: 3.02, 95% CI: 1.71-5.38, p<0.001). Improvement in functional class was addressed by another study with a different methodology, which showed that self-assessed functional class two months after CRT was a strong predictor of long-term survival (HR: 0.59, 95% CI: 0.40-0.87, p<0.007).<a class="elsevierStyleCrossRef" href="#bib0375">34</a> These studies show that symptomatic response after CRT is associated with better survival and are consistent with data previously described by Molhoek et al.<a class="elsevierStyleCrossRef" href="#bib0380">35</a> and Cha et al.<a class="elsevierStyleCrossRef" href="#bib0385">36</a> Moreover, the low annual mortality in our population (≈8%) confirms the synergistic interaction between administration of neurohumoral antagonists, CRT, and cardioverter-defibrillator implantation in a daily practice setting.Lower LVEF at baseline was also related to mortality in our study. This is supported by a large multicenter prospective study.<a class="elsevierStyleCrossRef" href="#bib0390">37</a> In addition, significant mitral regurgitation (grade >2+) post-CRT was found to be independently associated with all-cause mortality, as also described in the Cardiac Resynchronization in Heart Failure Trial<a class="elsevierStyleCrossRef" href="#bib0395">38</a> and by van Bommel et al.<a class="elsevierStyleCrossRef" href="#bib0400">39</a> Another clinical parameter with impact on mortality was hospitalization due to HF during the first year of follow-up. The importance of HF admissions after CRT was also shown by Bertini et al.,<a class="elsevierStyleCrossRef" href="#bib0305">20</a> and data from the MADIT-CRT trial revealed an association between future events and HF admission during the 12 months before CRT implantation.<a class="elsevierStyleCrossRef" href="#bib0405">40</a>Finally, these data indicate that lack of clinical improvement in patients without LVRR after CRT was a strong marker of worse prognosis. Its effect was independent of age, renal function and right ventricular dysfunction.LimitationsThis was a retrospective, single-center, non-randomized and non-controlled study, and this should be taken into consideration when interpreting the results. Notwithstanding, this represents a real-life group of patients followed in a referral center. Secondly, clinical response was based on improvement in NYHA class and did not include assessment of functional capacity or quality of life scores. Thirdly, clinical and echocardiographic response was considered at six-month follow-up, but some patients may have had late LVRR.<a class="elsevierStyleCrossRef" href="#bib0410">41</a> Fourthly, there will always be a certain degree of intra- and inter-observer variability in analysis of echocardiographic parameters, whatever the operator's expertise. Fifthly, other parameters such as position of the left ventricular lead, device programming, presence of rhythm abnormalities, extent of myocardial scar and brain natriuretic peptide levels were not addressed in this study. Finally, due to the small number of patients included in the study, its findings regarding predictors of all-cause mortality need confirmation in large-scale prospective studies.ConclusionsHF patients treated with CRT without LVRR at mid-term follow-up had a worse long-term prognosis than patients with LVRR, with a high rate of hospitalizations due to HF and all-cause mortality. However, among these patients, clinical response appeared to be independently associated with better survival. Further studies are needed to clarify the prognostic impact of a sustained clinical response in the absence of LVRR following CRT.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres959879" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 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" => "xpalclavsec930780" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres959878" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec930781" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Baseline patient characteristics" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical outcomes in the overall population" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Patients without left ventricular reverse remodeling" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical response, mortality and hospitalizations due to heart failure" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-26" "fechaAceptado" => "2017-02-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec930780" "palabras" => array:4 [ 0 => "Heart failure" 1 => "Cardiac resynchronization therapy" 2 => "Clinical response" 3 => "Prognosis" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec930781" "palabras" => array:4 [ 0 => "Insuficiência cardíaca" 1 => "Terapia de ressincronização cardíaca" 2 => "Resposta clínica" 3 => "Prognóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesLeft ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. MethodsWe analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. ResultsAt six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). ConclusionAlthough patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 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" => "Introdução e objetivosA remodelagem reversa do ventrículo esquerdo (RRVE) tem sido fortemente relacionada com o prognóstico em longo prazo de doentes submetidos à terapia de ressincronização cardíaca (TRC). O objetivo deste estudo foi avaliar o desfecho clínico a longo prazo de doentes sem RRVE aos seis meses após a implantação de TRC e definir o impacto prognóstico da resposta clínica nessa população. MétodosForam analisados 178 doentes submetidos à implantação de TRC (64±11 anos, 69% do sexo masculino, 89% da classe funcional III da New York Heart Association (NYHA), 35% com cardiomiopatia isquémica). O estadio clínico e a avaliação ecocardiográfica foram feitos antes e após seis meses de TRC. Foram identificados aqueles que não tinham critérios de RRVE (aumento ≥ 10% na fração de ejeção com uma redução de ≥ 15% na dimensão sistólica do ventrículo esquerdo). Os respondedores clínicos foram definidos por uma melhoria sustentada de pelo menos uma classe funcional NYHA. ResultadosAos seis meses de avaliação após TRC, 109 (61%) doentes apresentaram RRVE. Durante um seguimento médio de 56±21 meses, 47 (26%) doentes morreram, com maior mortalidade no grupo sem RRVE (36% versus 20%, p=0,023). A resposta clínica foi maior no grupo de doentes com RRVE (88% versus 55%, p<0,001). Em doentes sem RRVE, a resposta clínica à TRC foi o maior preditor independente de sobrevida (hazard ratio: 0,120; IC95%: 0,039-0,366; p<0,001). ConclusãoEmbora doentes sem RRVE seis meses após a implantação da TRC apresentem um pior prognóstico com maior taxa de mortalidade por todas as causas, a resposta clínica pode ser um preditor independente de sobrevida nessa população." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "List of abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:11 [ 0 => array:2 [ "termino" => "AV" "descripcion" => "atrioventricular" ] 1 => array:2 [ "termino" => "BMI" "descripcion" => "body mass index" ] 2 => array:2 [ "termino" => "CRT" "descripcion" => "cardiac resynchronization therapy" ] 3 => array:2 [ "termino" => "HF" "descripcion" => "heart failure" ] 4 => array:2 [ "termino" => "LBBB" "descripcion" => "left bundle branch block" ] 5 => array:2 [ "termino" => "LVEDD" "descripcion" => "left ventricular end-diastolic diameter" ] 6 => array:2 [ "termino" => "LVEF" "descripcion" => "left ventricular ejection fraction" ] 7 => array:2 [ "termino" => "LVESV" "descripcion" => "left ventricular end-systolic volume" ] 8 => array:2 [ "termino" => "LVRR" "descripcion" => "left ventricular reverse remodeling" ] 9 => array:2 [ "termino" => "NYHA" "descripcion" => "New York Heart Association" ] 10 => array:2 [ "termino" => "VV" "descripcion" => "interventricular" ] ] ] ] ] ] "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" => 2396 "Ancho" => 1497 "Tamanyo" => 200701 ] ] "descripcion" => array:1 [ "en" => "Kaplan-Meier curves of all-cause mortality and hospitalizations due to heart failure. (A) The probability of all-cause mortality differed significantly between clinical responders and non-responders; (B) the probability of all-cause mortality and hospitalizations due to heart failure differed significantly between clinical responders and non-responders." ] ] 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" => "BMI: body mass index; COPD: chronic obstructive pulmonary disease; CrCl: creatinine clearance; HF: heart failure; ICD: implantable cardioverter-defibrillator; LBBB: left bundle branch block; LVEDD: left ventricular end-systolic diameter; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-diastolic diameter; LVRR: left ventricular reverse remodeling; NYHA: New York Heart Association." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \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">All patients (n=178) \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">LVRR (n=109) \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">No LVRR (n=69) \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, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.880 \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">Male gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">123 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66 (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \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">Ischemic etiology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \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">NYHA class, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.010 \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">NYHA class ≥III, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165 (93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">106 (97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight, kg, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.609 \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, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \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">Obesity, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.058 \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">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">136 (76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 (79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.358 \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">Dyslipidemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.433 \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">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \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">History of smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (48) \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><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.303 \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">Previous heart surgery, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (30) \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">Prosthetic valve, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.584 \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">Creatinine, mg/dl, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.17±0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.13±0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.26±0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.170 \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">CrCl, ml/min/1.73 m2, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75±33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77±34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.164 \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">CrCl <60 ml/min/1.73 m2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \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">Sinus rhythm, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">108 (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (42) \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">LBBB, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 (89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">QRS duration, ms, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">167±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">170±29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">162±32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.104 \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">QRS duration >150 ms, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">129 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81 (74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.191 \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">LVEDD, mm, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \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">LVESD, mm, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63±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">LVEF, %, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.037 \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">ICD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">163 (92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101 (93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.584 \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">Clinical response, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">134 (75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (55) \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">Follow-up, months, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72±27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35±21 \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">All-cause mortality, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \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">Cardiac death, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (23) \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">Hospitalization for HF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (48) \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">All-cause mortality and/or hospitalization for HF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626444.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline clinical and echocardiographic characteristics." ] ] 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" => "AF: atrial fibrillation; Appropriate therapies: antitachycardia pacing and/or shock; BMI: body mass index; COPD: chronic obstructive pulmonary disease; CrCl: creatinine clearance; CRT: cardiac resynchronization therapy; HF: heart failure; LBBB: left bundle branch block; LVEDD: left ventricular end-systolic diameter; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-diastolic diameter; MR: mitral regurgitation; NYHA: New York Heart Association." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \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">Clinical responders (n=38) \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">Non-responders (n=31) \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, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.823 \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">Male gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.000 \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">Ischemic etiology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.811 \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">NYHA class, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.95±0.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.74±0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.074 \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">NYHA class ≥III, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.327 \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, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">Obesity, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.525 \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">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.307 \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">History of smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.456 \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">COPD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.379 \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">AF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.000 \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">CrCl, ml/min/1.73 m2, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.317 \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">CrCl <60 ml/min/1.73 m2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.094 \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">Previous heart surgery, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">LBBB, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.589 \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">QRS duration, ms, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">158±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">167±35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.398 \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">QRS duration >150 ms, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">LVEDD, mm, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.792 \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">LVESD, mm, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.912 \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">LVEF, %, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.401 \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">MR grade 3+ or 4+, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.000 \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">CRT optimization, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.000 \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">Follow-up, months, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40±23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30±18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.051 \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">Appropriate therapies, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.126 \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">All-cause mortality, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">Cardiac death, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">Hospitalization for HF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">All-cause mortality and/or hospitalization for HF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626445.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and echocardiographic characteristics according to clinical response in patients without left ventricular reverse remodeling." ] ] 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:2 [ "leyenda" => "CI: confidence interval; CRT: cardiac resynchronization therapy; HF: heart failure; HR: hazard ratio; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; RV: right ventricular.Renal dysfunction: glomerular filtration rate <60 ml/min/1.73 m2.RV dysfunction: tricuspid annular plane systolic excursion <16 mm or velocity of tricuspid annular systolic motion by tissue Doppler imaging <9.5 cm/s." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Dependent variable: all-cause mortality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR (95% CI) \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><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR (95% CI) \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">1.035 (1.007-1.080) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \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">Renal dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.861 (1.603-9.299) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \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">LVEF <20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.046 (1.056-4.681) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.768 (1.487-15.293) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MR post-CRT, grade 3+ or 4+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.081 (1.105-4.664) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.041 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.863 (1.139-7.196) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.025 \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">RV dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.117(1.199-8.101) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \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">Clinical response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.205 (0.084-0.501) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.120 (0.039-0.366) \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">Hospitalization for HF within 12 months of follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.102 (1.405-6.852) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.459 (1.030-5.870) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626443.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cox univariate and multivariate regression analysis for all-cause mortality." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0210" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). 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What happens to non-responders in cardiac resynchronization therapy?

O que acontece aos não respondedores na terapia de ressincronização cardíaca?

Pedro Rio

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pedrosantosrio@gmail.com

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, Mário Martins Oliveira, Pedro Silva Cunha, Manuel Nogueira da Silva, Luísa Moura Branco, Ana Galrinho, Rui Soares, Joana Feliciano, Ricardo Pimenta, Rui Cruz Ferreira

Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves of all-cause mortality and hospitalizations due to heart failure&#46; &#40;A&#41; The probability of all-cause mortality differed significantly between clinical responders and non-responders&#59; &#40;B&#41; the probability of all-cause mortality and hospitalizations due to heart failure differed significantly between clinical responders and non-responders&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy &#40;CRT&#41; is recommended by current guidelines for symptomatic heart failure &#40;HF&#41; with left ventricular ejection fraction &#40;LVEF&#41; &#8804;35&#37; and prolonged QRS interval&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1&#44;2</span></a> CRT is effective in improving HF symptoms&#44; exercise capacity&#44; quality of life and cardiac function&#44; as well as reducing HF hospitalizations and death&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">3&#8211;8</span></a> Trials have assessed the efficacy of CRT by means of improvement in clinical status and&#47;or reduction in left ventricular end-systolic volume &#40;LVESV&#41; at mid-term follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">9&#8211;12</span></a> Clinical and echocardiographic responses to CRT may not coincide&#44; but left ventricular reverse remodeling &#40;LVRR&#41; is considered a powerful indicator of clinical outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">13&#8211;15</span></a> Up to 40&#37; of patients will not experience significant reduction in left ventricular chamber size and are defined as CRT non-responders&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">16</span></a> Although this population has a poor prognosis&#44; little is known about the factors that influence their outcomes&#46; The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0065" class="elsevierStylePara elsevierViewall">This was a single-center study of patients who underwent successful CRT defibrillator device implantation between 2004 and 2012&#44; a total of 178 consecutive CRT recipients&#46; Patient data were prospectively collected in our cardiology department&#39;s information system and analyzed retrospectively&#46; Patients were selected for CRT if they met currently recommended criteria&#58; &#40;1&#41; LVEF &#8804;35&#37;&#59; &#40;2&#41; symptoms of HF&#44; defined as New York Heart Association &#40;NYHA&#41; class II-IV despite optimal medical therapy&#59; and &#40;3&#41; QRS duration &#8805;120 ms&#46; Patients were classified as ischemic in the presence of significant coronary artery disease &#40;&#62;50&#37; stenosis of two or more epicardial vessels or the left main&#44; or &#62;50&#37; stenosis of the proximal left anterior descending coronary artery on coronary angiography&#44; and&#47;or a history of previous myocardial infarction or myocardial revascularization&#41;&#46; All other patients were classified as non-ischemic&#46; Leads were placed transvenously&#44; via the subclavian and cephalic route&#44; using fluoroscopy to visualize their progression and location&#46; The right ventricular lead was positioned in the apex or mid septum&#46; The left ventricular lead was placed with an over-the-wire system in a posterolateral or lateral tributary vein of the coronary sinus depending on ability to cannulate the veins&#44; pacing threshold&#44; or diaphragmatic stimulation&#46; The standard settings included an atrioventricular &#40;AV&#41; delay of 100 ms &#40;sensed&#41; and 130 ms &#40;paced&#41;&#44; with DDD or DDDR mode and standard lower &#40;50 beats&#47;min&#41; and upper &#40;120-130 beats&#47;min&#41; pacing rates&#46; Extensive demographic and clinical data&#44; including mortality&#44; NYHA class and hospitalization for worsening HF were collected from medical records&#46; Clinical response to CRT was defined as a sustained improvement of &#8805;1 NYHA functional class at six-month follow-up&#46; Transthoracic two-dimensional echocardiographic information was assessed at baseline and six months after CRT device implantation&#46; LVRR was defined as an increase of &#8805;10&#37; in LVEF over baseline combined with &#8805;15&#37; reduction in left ventricular end-systolic diameter &#40;LVESD&#41;&#46; Cardiac structure and function were assessed using a commercially available ultrasound system &#40;Vivid-7 and Vivid-E9&#59; GE Vingmed Ultrasound&#44; Horten&#44; Norway&#41; equipped with a 3&#46;5-MHz transducer&#46; LVESD&#44; left ventricular end-diastolic diameter &#40;LVEDD&#41; and LVEF were determined according to standard techniques and digitally stored for offline analysis in cine-loop format&#46; Echocardiographic CRT optimization was performed if patients presented AV and&#47;or interventricular &#40;VV&#41; dyssynchrony&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">17</span></a> Optimization was based on the iterative method&#44; analyzing changes in left ventricular inflow and outflow&#44; while AV and&#47;or VV delays were changed in 10- or 20-ms steps&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Follow-up data were obtained by review of medical records&#44; outpatient clinic visits&#44; and telephone contact&#46; Ethics committee and hospital permission were obtained from the appropriate local authorities&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Data are expressed as mean &#177; standard deviation for continuous variables and as frequencies and percentages for categorical variables&#46; Data distribution was tested for normality using the Kolmogorov-Smirnov or Shapiro-Wilk test as appropriate&#46; Missing patient-level covariates were assumed to be missing and no imputation was performed&#46; Comparisons of baseline characteristics and outcomes were performed using the chi-square test or Fisher&#39;s exact test&#44; as appropriate&#44; for categorical variables and the Student&#39;s t test or the Mann-Whitney test for continuous variables&#46; Cumulative event rates after CRT device implantation were calculated using the Kaplan-Meier method and the population without LVRR was classified according to clinical response&#46; Log-rank tests for time-to-event data with respect to all-cause mortality were used for statistical comparison between the patient groups&#46; Multivariate Cox proportional hazards models were constructed with backward selection to identify independent predictors of all-cause mortality&#46; All significant univariate clinical and echocardiographic predictors at baseline and hospitalizations for HF during follow-up were entered in the multivariate model as covariates&#46; All statistical tests were two-sided&#44; and a p-value &#60;0&#46;05 was considered significant&#46; SPSS version 21 software &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#41; was used for computation&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Baseline patient characteristics</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study population consisted of 178 consecutive patients who underwent successful CRT device implantation &#40;age 64&#177;11 years&#59; 69&#37; male&#41;&#46; Baseline patient characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Sixty-nine patients &#40;39&#37;&#41; failed to show an increase of &#8805;10&#37; in LVEF and &#8805;15&#37; reduction in LVESD at six-month follow-up &#40;non-LVRR group&#41;&#46; The majority of the cohort &#40;65&#37;&#41; had non-ischemic cardiomyopathy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding differences between the groups&#44; patients without LVRR tended to be male &#40;83&#37; vs&#46; 61&#37; p&#61;0&#46;003&#41;&#44; to have ischemic cardiomyopathy &#40;49&#37; vs&#46; 26&#37;&#44; p&#61;0&#46;002&#41; and to show more severe baseline HF &#40;NYHA &#8805;III 83&#37; vs&#46; 97&#37;&#44; p&#61;0&#46;01&#41;&#46; Also&#44; no LVRR after CRT was associated with smoking &#40;47&#37; vs&#46; 25&#37;&#44; p&#61;0&#46;004&#41;&#44; lower body mass index &#40;BMI&#41; &#40;26 vs&#46; 28 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;042&#41;&#44; previous heart surgery &#40;30&#37; vs&#46; 13&#37;&#44; p&#61;0&#46;006&#41;&#44; renal dysfunction &#40;46&#37; vs&#46; 27&#37;&#44; p&#61;0&#46;017&#41;&#44; higher LVEDD &#40;77 vs&#46; 72 mm&#44; p&#61;0&#46;003&#41; and LVESD &#40;63 vs&#46; 51 mm p&#60;0&#46;001&#41;&#44; and reduced LVEF &#40;24&#37; vs&#46; 26&#37;&#44; p&#61;0&#46;037&#41;&#46; On the other hand&#44; CRT response was associated with sinus rhythm &#40;73&#37; vs&#46; 42&#37;&#44; p&#60;0&#46;001&#41; and with left bundle branch block &#40;LBBB&#41; &#40;89&#37; vs&#46; 72&#37;&#44; p&#61;0&#46;007&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical outcomes in the overall population</span><p id="par0090" class="elsevierStylePara elsevierViewall">During a mean follow-up of 56&#177;21 months&#44; 47 &#40;26&#37;&#41; patients died&#44; 21 &#40;45&#37;&#41; due to cardiac causes&#44; 45 &#40;25&#37;&#41; patients were hospitalized due to HF&#44; and 70 &#40;39&#37;&#41; patients died or were hospitalized due to HF&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Five-year overall mortality was 39&#46;2&#37;&#44; two-year mortality was 12&#46;6&#37; and one-year mortality was 6&#46;7&#37;&#46; Annual mortality was 7&#46;8&#37; overall&#46; The group with no LVRR showed higher mortality &#40;36&#37; vs&#46; 20&#37;&#44; p&#61;0&#46;023&#41;&#44; with more deaths of cardiac cause &#40;23&#37; vs&#46; 5&#37;&#44; p&#61;0&#46;001&#41;&#44; and higher rates of hospitalizations due to HF &#40;48&#37; vs&#46; 11&#37;&#44; p&#60;0&#46;001&#41;&#46; Clinical response was found to be greater in the LVRR group &#40;88&#37; vs&#46; 55&#37;&#44; p&#60;0&#46;001&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patients without left ventricular reverse remodeling</span><p id="par0100" class="elsevierStylePara elsevierViewall">There were thirty-eight patients &#40;55&#37;&#41; with an improvement of &#8805;1 NYHA functional class &#40;clinical response to CRT&#41; among the 69 patients without LVRR&#46; Mean NYHA class improved from 2&#46;86&#177;0&#46;46 at implantation to 2&#46;19&#177;0&#46;71 at six-month follow-up &#40;p&#60;0&#46;001&#44; 95&#37; confidence interval &#91;CI&#93;&#44; 0&#46;50-0&#46;83&#41;&#46; No difference was observed between ischemic and nonischemic cardiomyopathy &#40;p&#61;0&#46;81&#41;&#46; Comparison of clinical and echocardiographic data between the two groups &#40;clinical responders vs&#46; non-responders among patients without LVRR&#41; at six-month follow-up are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were no differences between the groups in age&#44; gender&#44; baseline NYHA class&#44; BMI&#44; history of diabetes or smoking&#44; atrial fibrillation&#44; renal dysfunction&#44; previous heart surgery&#44; prevalence of LBBB&#44; QRS duration&#44; left ventricular dimensions or systolic function&#44; baseline mitral regurgitation or echocardiographic CRT optimization during follow-up&#46; Twenty-five &#40;36&#37;&#41; patients died&#44; with higher mortality in the non-responders &#40;58&#37; vs&#46; 18&#37;&#44; p&#61;0&#46;001&#41;&#46; Thirty-three patients &#40;48&#37;&#41; were hospitalized due to HF &#40;58&#37; vs&#46; 40&#37;&#44; p&#61;0&#46;151&#41; and 24 patients &#40;35&#37;&#41; received appropriate therapies for ventricular tachyarrhythmias &#40;26&#37; vs&#46; 46&#37;&#44; p&#61;0&#46;126&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Clinical response&#44; mortality and hospitalizations due to heart failure</span><p id="par0105" class="elsevierStylePara elsevierViewall">Non-responders to CRT among patients without LVRR was significantly associated with all-cause mortality&#44; cardiac death and the combined endpoint &#40;all-cause mortality and hospitalization due to HF&#41;&#46; When the population was classified according to clinical response to CRT&#44; a cumulative 3&#37;&#44; 4&#37;&#44; and 10&#37; of the patients with improvement of &#8805;1 NYHA functional class died at 12-&#44; 24-&#44; and 36-month follow-up&#44; respectively&#46; In contrast&#44; 10&#37;&#44; 29&#37;&#44; and 52&#37; of the patients without improvement of &#8805;1 NYHA functional class died during the same period&#44; respectively &#40;log-rank p&#60;0&#46;001&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Also&#44; a cumulative 11&#37;&#44; 18&#37;&#44; and 38&#37; of the patients with improvement of &#8805;1 NYHA functional class had the combined endpoint by 12-&#44; 24-&#44; and 36-month follow-up&#44; respectively&#44; and 32&#37;&#44; 54&#37;&#44; and 67&#37; of the patients without improvement of &#8805;1 NYHA functional class had the combined endpoint during the same period &#40;log-rank p&#61;0&#46;002&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">To determine whether clinical response in patients without LVRR was an independent predictor of all-cause mortality during follow-up&#44; univariate predictors with a p-value &#60;0&#46;05 were entered into a Cox proportional hazards model as covariates &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; On multivariate analysis&#44; clinical response &#40;hazard ratio &#91;HR&#93;&#58; 0&#46;120&#59; 95&#37; CI&#58; 0&#46;039-0&#46;366&#59; p&#60;0&#46;001&#41; was independently associated with better survival&#46; Reduced LVEF at baseline &#40;HR&#58; 4&#46;768&#59; 95&#37; CI&#58; 1&#46;487-15&#46;293&#59; p&#61;0&#46;009&#41;&#44; significant mitral regurgitation &#40;grade &#62;2&#43;&#41; post-CRT &#40;HR&#58; 2&#46;863&#59; 95&#37; CI&#58; 1&#46;139-7&#46;196&#59; p&#61;0&#46;025&#41; and hospitalization due to HF within 12 months of follow-up &#40;HR&#58; 2&#46;459&#59; 95&#37; CI&#58; 1&#46;030-5&#46;870&#59; p&#61;0&#46;043&#41; were associated with higher all-cause mortality&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">As expected&#44; the main cause of mortality was cardiac death &#40;16 out of 25 patients&#41;&#46; Interestingly&#44; non-responders died more frequently for cardiovascular reasons compared with responders&#44; although this was not statistically significant &#40;13 &#91;72&#37;&#93; vs&#46; 3 &#91;43&#37;&#93;&#44; p&#61;0&#46;205&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The major findings of the present study&#44; which focused on the prognostic impact of clinical response to CRT in patients without LVRR six months after CRT&#44; are&#58; first&#44; the majority of patients &#40;61&#37;&#41; presented evidence of LVRR&#59; second&#44; the overall clinical response rate was 75&#37;&#59; third&#44; patients with LVRR had higher survival rates and less hospitalizations due to HF&#59; fourth&#44; among patients without LVRR&#44; 55&#37; presented long-term improvement of &#8805;1 NYHA functional class&#59; fifth&#44; clinical response was the strongest independent predictor of survival in patients without LVRR&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Several studies have confirmed the favorable impact on mortality and morbidity of CRT in mid- to long-term follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">6&#8211;12</span></a> In our cohort&#44; patients with LVRR showed better clinical outcomes&#44; with higher survival rates &#40;80&#37; vs&#46; 64&#37;&#44; p&#61;0&#46;023&#41; and less hospitalizations due to HF &#40;11&#37; vs&#46; 48&#37;&#44; p&#60;0&#46;001&#41;&#46; This survival benefit may be related to the occurrence and extent of LVRR in mid-term follow-up&#44; rather than to improvement in NYHA functional class&#44; according to other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">12&#8211;16&#44;18&#8211;20</span></a> Results of the REVERSE&#44; MADIT-CRT&#44; and RAFT trials showed that reduction in HF readmissions and improvement in long-term survival appear to be related to LVRR and improvement of left ventricular performance rather than improvements in NYHA functional class&#44; since the patients included were asymptomatic or only mildly symptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">12&#44;18&#44;19</span></a> Yu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">13</span></a> showed in 141 HF patients that reductions of &#8805;10&#37; in LVESV were independently associated with mid-term outcome after CRT and that improvement in clinical parameters was not predictive of long-term survival&#46; In a retrospective and non-randomized study&#44; Bertini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">20</span></a> concluded that reduction in LVESV in mid-term follow-up was a better predictor of long-term survival than improvement in clinical status&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">According to these data&#44; LVRR should be a more suitable surrogate to assess the efficacy of CRT than subjective clinical parameters&#46; Unfortunately&#44; there are a significant proportion of non-responders to CRT&#44; ranging between 17 and 46&#37;&#44; depending on the criteria used&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">21</span></a> In our study&#44; 39&#37; of patients did not present LVRR&#46; The factors mainly identified as contributors to lack of response to CRT are ischemic etiology&#44; shorter QRS duration and less baseline mechanical dyssynchrony&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">22&#8211;24</span></a> We also found that non-ischemic cardiomyopathy &#40;74&#37; vs&#46; 51&#37;&#44; p&#61;0&#46;002&#41; and LBBB &#40;89&#37; vs&#46; 72&#37;&#44; p&#61;0&#46;007&#41; were associated with LVRR&#46; QRS duration was not found to be statistically associated with LVRR&#44; probably due to the size of our study population&#46; Female gender was associated with LVRR &#40;39&#37; vs&#46; 17&#37;&#44; p&#61;0&#46;003&#41;&#44; in agreement with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In the present study&#44; 75&#37; of patients referred for CRT presented a clinical response in long-term follow-up&#46; This higher rate of clinical response compared to LVRR is in line with previous studies&#44; in which clinical responders range between 61&#37; and 77&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">23&#44;27&#8211;29</span></a> with a mean of 66&#46;9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">30</span></a> Although improvement in NYHA functional class and LVRR are connected&#44; the concordance between the two response types is not perfect&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">24</span></a> In the present study&#44; 28&#37; of patients &#40;38 out of 134&#41; with clinical improvement did not have LVRR&#46; Previous studies found similar results&#44; with a rate of disagreement of around 28&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">25&#44;29&#8211;32</span></a> The follow-up profile in the presence of clinical improvement without LVRR is not well known&#46; It has been questioned whether this change is due to a placebo effect or should also be considered a positive response to CRT&#46; Patients with improvement of &#8805;1 NYHA class among those without LVRR at six months after CRT showed lower all-cause mortality &#40;18&#37; vs&#46; 58&#37;&#44; p&#61;0&#46;001&#41;&#46; Also&#44; on multivariate analysis&#44; clinical response was independently associated with better survival &#40;HR&#58; 0&#46;120&#44; 95&#37; CI&#58; 0&#46;039-0&#46;366&#44; p&#60;0&#46;001&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">These conflicting findings&#44; which contrast with previously reported results&#44; should be interpreted with caution because of the retrospective nature of the analysis and the size of the study population&#46; Despite this&#44; our results show some similarities with published data&#46; In a study of 174 HF patients&#44; Kronborg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">33</span></a> found that clinical response to CRT was an independent predictor of mortality in very long-term follow-up &#40;HR&#58; 3&#46;02&#44; 95&#37; CI&#58; 1&#46;71-5&#46;38&#44; p&#60;0&#46;001&#41;&#46; Improvement in functional class was addressed by another study with a different methodology&#44; which showed that self-assessed functional class two months after CRT was a strong predictor of long-term survival &#40;HR&#58; 0&#46;59&#44; 95&#37; CI&#58; 0&#46;40-0&#46;87&#44; p&#60;0&#46;007&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">34</span></a> These studies show that symptomatic response after CRT is associated with better survival and are consistent with data previously described by Molhoek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a> and Cha et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">36</span></a> Moreover&#44; the low annual mortality in our population &#40;&#8776;8&#37;&#41; confirms the synergistic interaction between administration of neurohumoral antagonists&#44; CRT&#44; and cardioverter-defibrillator implantation in a daily practice setting&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Lower LVEF at baseline was also related to mortality in our study&#46; This is supported by a large multicenter prospective study&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">37</span></a> In addition&#44; significant mitral regurgitation &#40;grade &#62;2&#43;&#41; post-CRT was found to be independently associated with all-cause mortality&#44; as also described in the Cardiac Resynchronization in Heart Failure Trial<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a> and by van Bommel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">39</span></a> Another clinical parameter with impact on mortality was hospitalization due to HF during the first year of follow-up&#46; The importance of HF admissions after CRT was also shown by Bertini et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">20</span></a> and data from the MADIT-CRT trial revealed an association between future events and HF admission during the 12 months before CRT implantation&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; these data indicate that lack of clinical improvement in patients without LVRR after CRT was a strong marker of worse prognosis&#46; Its effect was independent of age&#44; renal function and right ventricular dysfunction&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">This was a retrospective&#44; single-center&#44; non-randomized and non-controlled study&#44; and this should be taken into consideration when interpreting the results&#46; Notwithstanding&#44; this represents a real-life group of patients followed in a referral center&#46; Secondly&#44; clinical response was based on improvement in NYHA class and did not include assessment of functional capacity or quality of life scores&#46; Thirdly&#44; clinical and echocardiographic response was considered at six-month follow-up&#44; but some patients may have had late LVRR&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a> Fourthly&#44; there will always be a certain degree of intra- and inter-observer variability in analysis of echocardiographic parameters&#44; whatever the operator&#39;s expertise&#46; Fifthly&#44; other parameters such as position of the left ventricular lead&#44; device programming&#44; presence of rhythm abnormalities&#44; extent of myocardial scar and brain natriuretic peptide levels were not addressed in this study&#46; Finally&#44; due to the small number of patients included in the study&#44; its findings regarding predictors of all-cause mortality need confirmation in large-scale prospective studies&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">HF patients treated with CRT without LVRR at mid-term follow-up had a worse long-term prognosis than patients with LVRR&#44; with a high rate of hospitalizations due to HF and all-cause mortality&#46; However&#44; among these patients&#44; clinical response appeared to be independently associated with better survival&#46; Further studies are needed to clarify the prognostic impact of a sustained clinical response in the absence of LVRR following CRT&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Introduction and Objectives"
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              "titulo" => "Introdu&#231;&#227;o e objetivos"
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              "titulo" => "M&#233;todos"
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          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Baseline patient characteristics"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Clinical outcomes in the overall population"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Patients without left ventricular reverse remodeling"
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              "identificador" => "sec0040"
              "titulo" => "Clinical response&#44; mortality and hospitalizations due to heart failure"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2016-11-26"
    "fechaAceptado" => "2017-02-23"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec930780"
          "palabras" => array:4 [
            0 => "Heart failure"
            1 => "Cardiac resynchronization therapy"
            2 => "Clinical response"
            3 => "Prognosis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec930781"
          "palabras" => array:4 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Terapia de ressincroniza&#231;&#227;o card&#237;aca"
            2 => "Resposta cl&#237;nica"
            3 => "Progn&#243;stico"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left ventricular reverse remodeling &#40;LVRR&#41; is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy &#40;CRT&#41;&#46; The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We analyzed 178 consecutive patients who underwent successful CRT device implantation &#40;age 64&#177;11 years&#59; 69&#37; male&#59; 89&#37; in New York Heart Association &#91;NYHA&#93; functional class III&#59; 35&#37; with ischemic cardiomyopathy&#41;&#46; Clinical status and echocardiographic parameters were determined before and six months after CRT implantation&#46; We identified those without criteria for LVRR &#40;&#8805;10&#37; increase in left ventricular ejection fraction with &#8805;15&#37; reduction in left ventricular end-systolic diameter compared to baseline&#41;&#46; Clinical responders were defined by a sustained improvement of at least one NYHA functional class&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At six-month assessment after CRT&#44; 109 &#40;61&#37;&#41; patients showed LVRR&#46; During a mean follow-up of 56&#177;21 months&#44; 47 &#40;26&#37;&#41; patients died&#44; with higher mortality in the group without LVRR &#40;36&#37; vs&#46; 20&#37;&#44; p&#61;0&#46;023&#41;&#46; Clinical response was greater in patients with LVRR &#40;88&#37; vs&#46; 55&#37;&#44; p&#60;0&#46;001&#41;&#46; In patients without LVRR&#44; clinical response to CRT was the strongest independent predictor of survival &#40;hazard ratio&#58; 0&#46;120&#59; 95&#37; confidence interval&#58; 0&#46;039-0&#46;366&#59; 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">Although patients without LVRR six months after CRT implantation had a worse prognosis&#44; with higher all-cause mortality&#44; clinical response can be an independent predictor of survival in this population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusion"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A remodelagem reversa do ventr&#237;culo esquerdo &#40;RRVE&#41; tem sido fortemente relacionada com o progn&#243;stico em longo prazo de doentes submetidos &#224; terapia de ressincroniza&#231;&#227;o card&#237;aca &#40;TRC&#41;&#46; O objetivo deste estudo foi avaliar o desfecho cl&#237;nico a longo prazo de doentes sem RRVE aos seis meses ap&#243;s a implanta&#231;&#227;o de TRC e definir o impacto progn&#243;stico da resposta cl&#237;nica nessa popula&#231;&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram analisados 178 doentes submetidos &#224; implanta&#231;&#227;o de TRC &#40;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11 anos&#44; 69&#37; do sexo masculino&#44; 89&#37; da classe funcional III da <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; 35&#37; com cardiomiopatia isqu&#233;mica&#41;&#46; O estadio cl&#237;nico e a avalia&#231;&#227;o ecocardiogr&#225;fica foram feitos antes e ap&#243;s seis meses de TRC&#46; Foram identificados aqueles que n&#227;o tinham crit&#233;rios de RRVE &#40;aumento &#8805; 10&#37; na fra&#231;&#227;o de eje&#231;&#227;o com uma redu&#231;&#227;o de &#8805; 15&#37; na dimens&#227;o sist&#243;lica do ventr&#237;culo esquerdo&#41;&#46; Os respondedores cl&#237;nicos foram definidos por uma melhoria sustentada de pelo menos uma classe funcional NYHA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Aos seis meses de avalia&#231;&#227;o ap&#243;s TRC&#44; 109 &#40;61&#37;&#41; doentes apresentaram RRVE&#46; Durante um seguimento m&#233;dio de 56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21 meses&#44; 47 &#40;26&#37;&#41; doentes morreram&#44; com maior mortalidade no grupo sem RRVE &#40;36&#37; <span class="elsevierStyleItalic">versus</span> 20&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46; A resposta cl&#237;nica foi maior no grupo de doentes com RRVE &#40;88&#37; <span class="elsevierStyleItalic">versus</span> 55&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Em doentes sem RRVE&#44; a resposta cl&#237;nica &#224; TRC foi o maior preditor independente de sobrevida &#40;<span class="elsevierStyleItalic">hazard ratio&#58;</span> 0&#44;120&#59; IC95&#37;&#58; 0&#44;039-0&#44;366&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>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">Embora doentes sem RRVE seis meses ap&#243;s a implanta&#231;&#227;o da TRC apresentem um pior progn&#243;stico com maior taxa de mortalidade por todas as causas&#44; a resposta cl&#237;nica pode ser um preditor independente de sobrevida nessa popula&#231;&#227;o&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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            "titulo" => "Resultados"
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      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:11 [
              0 => array:2 [
                "termino" => "AV"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">atrioventricular</p>"
              ]
              1 => array:2 [
                "termino" => "BMI"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">body mass index</p>"
              ]
              2 => array:2 [
                "termino" => "CRT"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiac resynchronization therapy</p>"
              ]
              3 => array:2 [
                "termino" => "HF"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">heart failure</p>"
              ]
              4 => array:2 [
                "termino" => "LBBB"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">left bundle branch block</p>"
              ]
              5 => array:2 [
                "termino" => "LVEDD"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">left ventricular end-diastolic diameter</p>"
              ]
              6 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              7 => array:2 [
                "termino" => "LVESV"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">left ventricular end-systolic volume</p>"
              ]
              8 => array:2 [
                "termino" => "LVRR"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">left ventricular reverse remodeling</p>"
              ]
              9 => array:2 [
                "termino" => "NYHA"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">New York Heart Association</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves of all-cause mortality and hospitalizations due to heart failure&#46; &#40;A&#41; The probability of all-cause mortality differed significantly between clinical responders and non-responders&#59; &#40;B&#41; the probability of all-cause mortality and hospitalizations due to heart failure differed significantly between clinical responders and non-responders&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; COPD&#58; chronic obstructive pulmonary disease&#59; CrCl&#58; creatinine clearance&#59; HF&#58; heart failure&#59; ICD&#58; implantable cardioverter-defibrillator&#59; LBBB&#58; left bundle branch block&#59; LVEDD&#58; left ventricular end-systolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; left ventricular end-diastolic diameter&#59; LVRR&#58; left ventricular reverse remodeling&#59; NYHA&#58; New York Heart Association&#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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline&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">All patients &#40;n&#61;178&#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">LVRR &#40;n&#61;109&#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">No LVRR &#40;n&#61;69&#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">Age&#44; years&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#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;880&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">Male gender&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;83&#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;003&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">Ischemic etiology&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;49&#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;002&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">NYHA class&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#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="left" valign="top">2&#46;9&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;010&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">NYHA class &#8805;III&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165 &#40;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;86&#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;016&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">Weight&#44; kg&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#177;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#177;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#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;609&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">BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#177;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;042&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">Obesity&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#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;058&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">Hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;73&#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;358&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">Dyslipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;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;433&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">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&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">History of smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;48&#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;004&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">COPD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;23&#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;303&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">Previous heart surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;30&#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;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">Prosthetic valve&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;10&#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;584&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">Creatinine&#44; mg&#47;dl&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;17&#177;0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;13&#177;0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;26&#177;0&#46;59&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;170&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">CrCl&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#177;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#177;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#177;30&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;164&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">CrCl &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;46&#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;017&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">Sinus rhythm&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#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">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LBBB&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">147 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;72&#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;007&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">QRS duration&#44; ms&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167&#177;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">170&#177;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">162&#177;32&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;104&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">QRS duration &#62;150 ms&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;68&#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;191&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">LVEDD&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#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">0&#46;003&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">LVESD&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#177;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#177;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#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">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF&#44; &#37;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#177;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#177;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#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;037&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">ICD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">163 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101 &#40;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;90&#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;584&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">Clinical response&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#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">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up&#44; months&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#177;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#177;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#177;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All-cause mortality&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;36&#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;023&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">Cardiac death&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;23&#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;001&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">Hospitalization for HF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All-cause mortality and&#47;or hospitalization for HF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; Appropriate therapies&#58; antitachycardia pacing and&#47;or shock&#59; BMI&#58; body mass index&#59; COPD&#58; chronic obstructive pulmonary disease&#59; CrCl&#58; creatinine clearance&#59; CRT&#58; cardiac resynchronization therapy&#59; HF&#58; heart failure&#59; LBBB&#58; left bundle branch block&#59; LVEDD&#58; left ventricular end-systolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; left ventricular end-diastolic diameter&#59; MR&#58; mitral regurgitation&#59; NYHA&#58; New York Heart Association&#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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline&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">Clinical responders &#40;n&#61;38&#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">Non-responders &#40;n&#61;31&#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">Age&#44; years&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;823&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">Male gender&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&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">Ischemic etiology&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;811&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">NYHA class&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;95&#177;0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;74&#177;0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;074&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">NYHA class &#8805;III&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;327&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">BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">Obesity&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;525&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">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;307&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">History of smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;456&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">COPD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;379&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">AF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&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">CrCl&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#177;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#177;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;317&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">CrCl &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;094&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">Previous heart surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">LBBB&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;589&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">QRS duration&#44; ms&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">158&#177;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167&#177;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;398&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">QRS duration &#62;150 ms&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">LVEDD&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;792&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">LVESD&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;912&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">LVEF&#44; &#37;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;401&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">MR grade 3&#43; or 4&#43;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&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">CRT optimization&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&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">Follow-up&#44; months&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#177;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#177;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;051&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">Appropriate therapies&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;126&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">All-cause mortality&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiac death&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalization for HF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">All-cause mortality and&#47;or hospitalization for HF&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical and echocardiographic characteristics according to clinical response in patients without left ventricular reverse remodeling&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; CRT&#58; cardiac resynchronization therapy&#59; HF&#58; heart failure&#59; HR&#58; hazard ratio&#59; LVEF&#58; left ventricular ejection fraction&#59; MR&#58; mitral regurgitation&#59; RV&#58; right ventricular&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Renal dysfunction&#58; glomerular filtration rate &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">RV dysfunction&#58; tricuspid annular plane systolic excursion &#60;16 mm or velocity of tricuspid annular systolic motion by tissue Doppler imaging &#60;9&#46;5 cm&#47;s&#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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Dependent variable&#58; all-cause mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR &#40;95&#37; CI&#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><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR &#40;95&#37; CI&#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">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;035 &#40;1&#46;007-1&#46;080&#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;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&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">Renal dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;861 &#40;1&#46;603-9&#46;299&#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;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&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">LVEF &#60;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;046 &#40;1&#46;056-4&#46;681&#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;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;768 &#40;1&#46;487-15&#46;293&#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;009&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">MR post-CRT&#44; grade 3&#43; or 4&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;081 &#40;1&#46;105-4&#46;664&#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;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;863 &#40;1&#46;139-7&#46;196&#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;025&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">RV dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;117&#40;1&#46;199-8&#46;101&#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;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&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">Clinical response&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 &#40;0&#46;084-0&#46;501&#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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;120 &#40;0&#46;039-0&#46;366&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalization for HF within 12 months of follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;102 &#40;1&#46;405-6&#46;852&#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;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;459 &#40;1&#46;030-5&#46;870&#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;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cox univariate and multivariate regression analysis for all-cause mortality&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:41 [
            0 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy&#58; the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology &#40;ESC&#41;&#46; Developed in collaboration with the European Heart Rhythm Association"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Brignole"
                            1 => "A&#46; Auricchio"
                            2 => "G&#46; Baron-Esquivias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/eht150"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "2281"
                        "paginaFinal" => "2329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23801822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;HRS&#47;AHA&#47;ASE&#47;HFSA&#47;SCAI&#47;SCCT&#47;SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy&#58; a report of the American College of Cardiology Foundation appropriate use criteria task force&#44; Heart Rhythm Society&#44; American Heart Association&#44; American Society of Echocardiography&#44; Heart Failure Society of America&#44; Society for Cardiovascular Angiography and Interventions&#44; Society of Cardiovascular Computed Tomography&#44; and Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Russo"
                            1 => "R&#46;F&#46; Stainback"
                            2 => "S&#46;R&#46; Bailey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.12.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "1318"
                        "paginaFinal" => "1368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23453819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization in chronic heart failure"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "MIRACLE Study Group&#46; Multicenter InSync Randomized Clinical Evaluation"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;T&#46; Abraham"
                            1 => "W&#46;G&#46; Fisher"
                            2 => "A&#46;L&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa013168"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2002"
                        "volumen" => "346"
                        "paginaInicial" => "1845"
                        "paginaFinal" => "1853"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2017.02.018

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	4	12
2024 October	38	31	69
2024 September	60	20	80
2024 August	54	30	84
2024 July	93	28	121
2024 June	26	16	42
2024 May	40	21	61
2024 April	34	29	63
2024 March	27	24	51
2024 February	25	15	40
2024 January	18	25	43
2023 December	27	25	52
2023 November	35	27	62
2023 October	36	19	55
2023 September	24	15	39
2023 August	26	21	47
2023 July	26	6	32
2023 June	32	21	53
2023 May	62	34	96
2023 April	53	7	60
2023 March	84	24	108
2023 February	64	22	86
2023 January	38	18	56
2022 December	71	20	91
2022 November	72	36	108
2022 October	83	42	125
2022 September	49	49	98
2022 August	46	33	79
2022 July	43	44	87
2022 June	48	26	74
2022 May	43	35	78
2022 April	47	43	90
2022 March	51	34	85
2022 February	56	36	92
2022 January	74	35	109
2021 December	44	37	81
2021 November	51	32	83
2021 October	54	48	102
2021 September	37	27	64
2021 August	44	28	72
2021 July	37	18	55
2021 June	51	21	72
2021 May	53	37	90
2021 April	98	27	125
2021 March	89	26	115
2021 February	81	31	112
2021 January	82	18	100
2020 December	54	12	66
2020 November	69	14	83
2020 October	75	21	96
2020 September	89	15	104
2020 August	46	19	65
2020 July	72	16	88
2020 June	56	19	75
2020 May	60	22	82
2020 April	56	10	66
2020 March	48	12	60
2020 February	109	24	133
2020 January	48	10	58
2019 December	38	5	43
2019 November	108	31	139
2019 October	42	9	51
2019 September	46	11	57
2019 August	36	8	44
2019 July	34	11	45
2019 June	30	18	48
2019 May	30	17	47
2019 April	26	17	43
2019 March	36	17	53
2019 February	41	14	55
2019 January	32	13	45
2018 December	41	12	53
2018 November	46	13	59
2018 October	46	8	54
2018 September	33	11	44
2018 August	34	4	38
2018 July	13	3	16
2018 June	30	6	36
2018 May	20	3	23
2018 April	27	3	30
2018 March	58	14	72
2018 February	51	12	63
2018 January	51	18	69
2017 December	26	9	35

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