Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response | Revista Portuguesa de Cardiologia (English edition)

array:24 ["pii" => "S2174204918300588" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.03.007" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1148" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2018;37:105-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1305 "formatos" => array:3 [ "EPUB" => 156 "HTML" => 914 "PDF" => 235 ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204918300096" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.01.005" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1151" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2018;37:115-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1629 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1164 "PDF" => 320 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial comment" "titulo" => "Reduction of systemic inflammation after cardiac resynchronization therapy: A new form of response?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "116" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Redução da inflamação sistémica após terapêutica de ressincronização cardíaca: uma nova forma de resposta?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natália António" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Natália" "apellidos" => "António" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255118300350" "doi" => "10.1016/j.repc.2018.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118300350?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300096?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300096/v1_201803200458/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204918300138" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.11.017" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1142" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2018;37:97-104" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1948 "formatos" => array:3 [ "EPUB" => 132 "HTML" => 1406 "PDF" => 410 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Perspectives in Cardiology" "titulo" => "Heart failure in numbers: Estimates for the 21st century in Portugal" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "104" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Insuficiência cardíaca em números: estimativas para o século XXI em Portugal" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1259 "Ancho" => 2331 "Tamanyo" => 140012 ] ] "descripcion" => array:1 [ "en" => "Estimated changes in numbers of patients with heart failure in mainland Portugal, by age group." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cândida Fonseca, Daniel Brás, Inês Araújo, Fátima Ceia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cândida" "apellidos" => "Fonseca" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Brás" ] 2 => array:2 [ "nombre" => "Inês" "apellidos" => "Araújo" ] 3 => array:2 [ "nombre" => "Fátima" "apellidos" => "Ceia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S087025511730745X" "doi" => "10.1016/j.repc.2017.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730745X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300138?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300138/v1_201803200458/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "105" "paginaFinal" => "113" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luís Almeida-Morais, Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Inês Rodrigues, Guilherme Portugal, Pedro Rio, Rui Soares, Miguel Mota Carmo, Rui Cruz Ferreira" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Luís" "apellidos" => "Almeida-Morais" "email" => array:1 [ 0 => "lmmorais88@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Abreu" ] 2 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] 4 => array:2 [ "nombre" => "Inês" "apellidos" => "Rodrigues" ] 5 => array:2 [ "nombre" => "Guilherme" "apellidos" => "Portugal" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Rio" ] 7 => array:2 [ "nombre" => "Rui" "apellidos" => "Soares" ] 8 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mota Carmo" ] 9 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro Universitário de Cardiologia, 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" => "Impacto da ressincronização cardíaca nos biomarcadores inflamatórios e de remodelagem cardíaca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1515 "Ancho" => 2307 "Tamanyo" => 79411 ] ] "descripcion" => array:1 [ "en" => "Correlation between C-reactive protein (CRP) levels and functional response to cardiac resynchronization therapy. Response was defined as a ≥10% increase in peak oxygen consumption (VO2 max). Δ CRP: variation in CRP levels." ] ] ] "textoCompleto" => "IntroductionCardiac resynchronization therapy (CRT) is an established treatment for patients with symptomatic chronic heart failure (CHF) and prolonged QRS despite optimal pharmacological therapy. By restoring the heart's electromechanical synchrony, CRT improves self-reported symptoms and reduces mortality and rehospitalization for heart failure.<a class="elsevierStyleCrossRefs" href="#bib0175">1–4</a> Response to CRT is associated with left ventricular reverse remodeling, which is objectively assessed through echocardiographic parameters, particularly improvement in left ventricular ejection fraction (LVEF) and reduction in left ventricular end-systolic volume (LVESV).<a class="elsevierStyleCrossRef" href="#bib0195">5</a> Nonetheless, up to 40% of CRT recipients are considered non-responders.<a class="elsevierStyleCrossRef" href="#bib0200">6</a> Improvement in New York Heart Association (NYHA) functional class and six-minute walk test distance have also been proposed as clinical response criteria in several studies.<a class="elsevierStyleCrossRefs" href="#bib0205">7,8</a> Improvement in peak oxygen uptake (VO2 max), a marker of functional status and activity, has been described after CRT device implantation in a small cohort of patients.<a class="elsevierStyleCrossRef" href="#bib0215">9</a> However, there is little agreement between the criteria of response, which suggests that clinical or functional improvement can occur without changes in echocardiographic parameters.<a class="elsevierStyleCrossRef" href="#bib0220">10</a>B-type natriuretic peptide (BNP) is a marker of volume and pressure overload that has been proposed as a diagnostic and prognostic tool in CHF, in which it correlates well with severity. Moreover, pharmacological therapies that improve CHF symptoms and outcomes have been shown to reduce BNP levels.<a class="elsevierStyleCrossRef" href="#bib0225">11</a> Studies have also reported significant reductions in plasma BNP levels after CRT device implantation.<a class="elsevierStyleCrossRefs" href="#bib0230">12–14</a> Systemic inflammation is also known to play a role in CHF,<a class="elsevierStyleCrossRef" href="#bib0245">15</a> and increased serum levels of inflammatory markers such as C-reactive protein (CRP) confer a dismal prognosis for CHF patients.<a class="elsevierStyleCrossRefs" href="#bib0250">16,17</a>Nonetheless, there are conflicting data concerning reductions in BNP and CRP as markers of neurohormonal and inflammatory status after CRT device implantation.<a class="elsevierStyleCrossRefs" href="#bib0225">11,12</a> Moreover, their association with CRT response criteria that assess different pathological pathways of the syndrome is not fully understood.Hence, this study aims primarily to assess variations in BNP and CRP six months after CRT device implantation, and secondarily to assess the association between changes in these laboratory variables and functional and echocardiographic response to CRT.MethodsPopulation and study designBetween April 2011 and December 2014, consecutive patients referred for CRT device implantation in a tertiary center were systematically included in a prospective cohort study. Indications for CRT followed current international guidelines.<a class="elsevierStyleCrossRef" href="#bib0335">18</a> All patients had been on optimal medical therapy for at least six months and were followed by a specialized heart failure team. A comprehensive assessment including demographic, clinical, laboratory, electrocardiographic, echocardiographic and cardiopulmonary exercise testing (CPET) was performed and data were collected at baseline and six months after device implantation and subsequently analyzed. The ethics committee of our university hospital center approved the study protocol and written consent was obtained for all patients.Demographic and clinical dataDemographic and clinical data were obtained through medical consultation at baseline and at six-month follow-up. Demographic variables included age and gender. Clinical variables included heart failure etiology, classical cardiovascular risk factors, comorbidities, ongoing medication and NYHA functional class. A 12-lead electrocardiogram was also obtained to determine heart rhythm, QRS width and intraventricular conduction pattern.Laboratory dataBlood samples were collected through peripheral venous catheterization into blood collection tubes with (serum) or without (plasma) anticoagulant (EDTA). All laboratory tests were performed after at least six hours fasting and at rest in a supine position in the same laboratory using hospital protocol, and assays were determined according to the manufacturer's recommendations. BNP was analyzed from plasma on a Spinchron DLX 800 (Beckman Coulter) centrifuge using a two-step chemiluminescence assay and serum CRP was determined with a nephelometer (Siemens BN ProSpecT).Transthoracic echocardiographyA complete transthoracic echocardiogram was performed in all patients using a Vivid E9 scanner (GE Healthcare) with a 3 MHz probe, at baseline and at six-month follow-up. M-mode, two-dimensional, color, pulsed, continuous wave and tissue Doppler data were obtained from parasternal and apical views, and the standard echocardiographic parameters were calculated. Acquired cine-loop images with at least three cardiac cycles were analyzed offline (EchoPAC software, GE Healthcare) for additional measures. LVEF, LVESV and left ventricular end-diastolic volume (LVEDV) were determined from apical 4- and 2-chamber views using Simpson's biplane method.<a class="elsevierStyleCrossRef" href="#bib0260">19</a> The mean of three measurements was considered for analysis. Endocardial borders were manually traced and the left ventricular papillary muscles were included in volume acquisition. All measurements were reviewed by the same echocardiographic operator. The intraclass correlation coefficient (ICC) was calculated for LVESV to assess intraobserver variability. Echocardiographic response to CRT was established as a ≥15% reduction in LVESV from baseline to six months after CRT device implantation, as previously published.<a class="elsevierStyleCrossRef" href="#bib0265">20</a>Cardiopulmonary exercise testingCPET with ventilatory expired gas analysis was performed in all patients at baseline and at six-month follow-up using the modified Bruce protocol. Exercise test duration, VO2 max and minute ventilation-carbon dioxide production slope (VE/VCO2) were determined. A significant functional response to CRT was defined as a ≥10% increase in VO2 max from baseline to six-month follow-up.<a class="elsevierStyleCrossRef" href="#bib0270">21</a>Cardiac resynchronization therapy device implantationCRT device implantation was performed through a transvenous approach, using the subclavian and cephalic veins. The right atrial lead was positioned in the right atrial appendage and the right ventricular lead was actively fixed in the right ventricular apex or interventricular septum. The left ventricular lead was introduced using a long guiding sheath in order to cannulate the coronary sinus. An angiogram was performed and then the lead was positioned preferably in a lateral or posterolateral vein.Statistical analysisBaseline demographic and clinical data were expressed as means and standard deviation for continuous variables and as percentages for categorical variables. Changes in BNP and CRP (Δ BNP and Δ CRP) were established by the arithmetic subtraction of their values at six-month follow-up from baseline. Normality (Gaussian distribution) was tested in all continuous variables using the Shapiro-Wilk test. To assess the association between continuous variables, Pearson's or Spearman's correlation was used for normally or non-normally distributed data, respectively. Δ BNP and Δ CRP were separately compared between echocardiographic and functional responders and non-responders using the Student's t or Mann-Whitney tests for normally or non-normally distributed variables, respectively. The chi-square test was used to compare dichotomous variables. The level of significance considered was α=0.05. Data were analyzed using SPSS for Windows, version 20.0 (IBM SPSS Inc, Chicago, IL).ResultsBaseline characteristicsA total of 115 patients underwent CRT device implantation for whom complete data were collected at baseline and six-month follow-up. Mean age was 68.6±10.5 years and 68.7% were male. Ischemic heart failure etiology was reported in 29.1%. Mean QRS width at baseline was 172.1±28.8 ms and complete left bundle branch block was present in 56% of patients. Beta-blockers were prescribed in 86.2% of patients and 88.6% were treated with renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). At baseline, 74.3% patients were in NYHA functional class III or IV. Clinical improvement of at least one NYHA class was observed in 81.3% of patients. CRP and BNP presented a statistically significant reduction from baseline to six-month follow-up (CRP 7.0±15.6 to 6.5±15.3 mg/l, p<0.001, and BNP 533.6±553.6 to 404.9±530.3 pg/ml, p<0.001). Echocardiographic response was observed in 51.4% and functional response in 59.2%, assessed by the above criteria. Response as assessed by echocardiography was not statistically correlated with functional response (r=0.14, p=0.433 and chi-square=0.063, p=0.80).<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> delineates the baseline demographic and clinical characteristics of responders and non-responders assessed by both sets of criteria independently. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> details laboratory, echocardiographic and CPET data at baseline and at six-month follow-up.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Echocardiographic responseIn our cohort, severely reduced mean LVEF at baseline was observed (26.4±7.0%). A significant improvement in mean LVEF and reduction in mean LVEDV and LVESV were noted after CRT device implantation. Additionally, 63.4% of patients showed more than 10% improvement in LVEF and in 51.4% of patients LVESV decreased by more than 15% compared to baseline (echocardiographic responders). An ICC of 0.89 at baseline and 0.87 at six-month follow-up was calculated for intraobserver variability of LVESV. BNP reduction was more pronounced in responders than in non-responders as assessed by echocardiography, although this did not achieve statistical significance (-144.7±260.2 vs. -66.1±538.2 pg/ml, p>0.05) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Echocardiographic responders also presented a non-significant reduction in serum CRP levels after CRT (-7.1±24.3 vs. 0.7±10.3 mg/l, p>0.05) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Functional responseVO2 max during CPET was severely depressed at baseline (mean 14.5±5.2 ml/min/kg). However, a statistically significant improvement (14.5±5.2 to 16.4±4.1 ml/min/kg, p<0.001) was observed after CRT device implantation. Improvement in exercise capacity was also shown by a significant reduction in VE/VCO2 slope and longer CPET duration (38.0±11.6 vs. 32.4±7.1 and 3.7±2.4 vs. 4.7±2.2 ms, respectively, all p<0.001) at six-month follow-up. BNP reduction was significantly more pronounced in those classified as functional responders (-167.6±264.1 pg/ml vs. -24.9±269.4 pg/ml, p=0.044) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). CRP reduction was seen in functional responders, while non-responders presented elevation in mean CRP levels six months after CRT device implantation (-1.6±4.4 vs. 2.4±9.9 mg/l, p=0.040) (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). A significant reduction in VE/VCO2 slope was also noted in functional responders (-9.8±10.5 vs. 1.9±7.2, p=0.001).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionIn our study population a significant reduction of CRP and BNP was observed six months after CRT (CRP 7.0±15.6 to 6.5±15.3 mg/l, p<0.001 and BNP 533.6±553.6 to 404.9±530.3 pg/ml, p<0.001). The CRP and BNP reductions were significantly higher in the functional responder group, whereas they did not achieve statistical significance in the echocardiographic responder group.Heart failure is a systemic condition with increased levels of natriuretic peptides and inflammatory markers.<a class="elsevierStyleCrossRefs" href="#bib0230">12,13</a> Therapies targeting these pathways have shown positive prognostic impact in this syndrome.<a class="elsevierStyleCrossRefs" href="#bib0225">11,17</a>As described, our cohort represents a severe heart failure population characterized by poor self-reported functional status, reduced exercise capacity and low mean LVEF. Moreover, compared to other studies, our population presented a higher proportion of nonischemic heart failure etiology, such as idiopathic, valvular and alcoholic, only 29.1% of patients having ischemic heart failure.<a class="elsevierStyleCrossRef" href="#bib0335">18</a> The heart failure etiology did not significantly differ between functional or echocardiographic responders and non-responders. Patients in our population presented advanced age, which excludes them from a heart transplantation program, and they were already on optimal medical therapy. Additionally, the high mean BNP and CRP levels presented at baseline support the concept of an advanced heart failure population, and significant reductions in BNP and CRP levels were observed at six-month follow-up after CRT device implantation, which is in line with previous studies.<a class="elsevierStyleCrossRefs" href="#bib0275">22–24,12</a>Response to CRT is the subject of considerable debate, since there is no established definition for therapeutic response.<a class="elsevierStyleCrossRef" href="#bib0265">20</a> Improvement in LVEF and reductions in LVESV and LVEDV are the result of left ventricular reverse remodeling. Pharmacological therapies targeting this effect have been shown to be associated with better long-term outcomes in heart failure patients.<a class="elsevierStyleCrossRefs" href="#bib0290">25–28</a> The cut-off of a ≥15% reduction in LVESV has been described as a more specific surrogate of left ventricular reverse remodeling than LVEF, and has been used to define those responding to CRT therapy by echocardiography.<a class="elsevierStyleCrossRefs" href="#bib0220">10,11,14,21</a> In our study, only 51.4% of patients achieved this demanding criterion at six months. These echocardiographic responders had a more pronounced reduction in BNP at six-month follow-up than non-responders, but this did not achieve statistical significance. Despite targeting the same mechanism, the demanding cut-off for LVESV reduction, the short follow-up time for structural changes and variability in BNP could explain this phenomenon. Regarding the changes in CRP, a widely used marker of systemic inflammation, there was no significant association with reduced LVESV, perhaps because they reflect different pathways of the pathological disease process. The association reported in the literature between reduced LVESV and changes in BNP or CRP after CRT has in fact been variable.<a class="elsevierStyleCrossRefs" href="#bib0240">14,28,29</a>Exercise capacity, measured through VO2 max during CPET, is known to be a major prognostic indicator in heart failure patients.<a class="elsevierStyleCrossRefs" href="#bib0315">30,31</a> It has been assessed in conjunction with pharmacological therapies for heart failure patients.<a class="elsevierStyleCrossRef" href="#bib0325">32</a> However, its use for determining functional response after CRT is not routinely considered and lacks clinical evidence. We used a cut-off of ≥10% improvement in VO2 max to define functional responders, and our study revealed significantly greater reductions in BNP and CRP among CRT patients in whom VO2 max improved substantially at six-month follow-up. An association between reductions in neurohormonal and inflammatory levels and a ≥10% improvement in VO2 max has not previously been reported in this population. Volume overload in heart failure is responsible for raised left ventricular and atrial pressure and consequently elevation of pulmonary capillary wedge pressure, which is associated with functional exercise impairment.<a class="elsevierStyleCrossRef" href="#bib0235">13</a> Moreover, systemic inflammatory markers increase oxygen demand, depress myocardial function and disturb homeostasis in the pulmonary vasculature, influencing the interaction between heart and lungs.<a class="elsevierStyleCrossRef" href="#bib0330">33</a> This finding suggests that electromechanical resynchronization may have a role in reversing these pathological processes, which highlights the importance of considering improvement in VO2 max after CRT as a response criterion.In our study, the association between reduced LVESV and improved VO2 max was non-significant, suggesting that those who improved by one criterion may not have improved by the other. Similarly, Fornwalt et al. showed that agreement between criteria of clinical, echocardiographic and functional exercise response after CRT device implantation is poor,<a class="elsevierStyleCrossRef" href="#bib0225">11</a> indicating that CRT may lead to improvements in different parameters in different patients. Functional response supported by reduction in BNP and CRP could be related to CRT response independently of significant left ventricular reverse remodeling at six-month follow-up.Study limitationsFollow-up time in this study was set at six months after CRT implantation, which may be insufficient to assess the long-term structural changes of left ventricular reverse remodeling. Moreover, inferences cannot be made about the lasting clinical, laboratory or echocardiographic alterations in this population after this time. Additionally, CRP levels are susceptible to variability, and ongoing inflammatory processes that influenced CRP levels cannot be excluded.ConclusionCRT was associated with important reductions in BNP and CRP levels at six-month follow-up. Patients presenting significantly improved functional capacity, considered functional responders, showed significant reductions in serum BNP and CRP levels at six-month follow-up, reflecting its benefit on ventricular remodeling and inflammation. In echocardiographic responders this effect was smaller and non-significant, which calls attention to the importance of assessing functional response in CRT patients.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1005646" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 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" => "xpalclavsec965433" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1005645" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 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" => "xpalclavsec965434" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population and study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Demographic and clinical data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Laboratory data" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Transthoracic echocardiography" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Cardiopulmonary exercise testing" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Cardiac resynchronization therapy device implantation" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Echocardiographic response" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Functional response" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-01" "fechaAceptado" => "2017-06-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec965433" "palabras" => array:4 [ 0 => "Heart failure" 1 => "Cardiac resynchronization therapy" 2 => "B-type natriuretic peptide" 3 => "C-reactive protein" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec965434" "palabras" => array:4 [ 0 => "Insuficiência cardíaca" 1 => "Terapia de ressincronização cardíaca" 2 => "Péptido natriurético tipo-B" 3 => "Proteína C-reactiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionResponse to cardiac resynchronization therapy (CRT) can currently be assessed by clinical or echocardiographic criteria, and there is no strong evidence supporting the use of one rather than the other. Reductions in B-type natriuretic peptide (BNP) and C-reactive protein (CRP) have been shown to be associated with CRT response. This study aims to assess variation in BNP and CRP six months after CRT and to correlate this variation with criteria of functional and echocardiographic response. MethodsPatients undergoing CRT were prospectively enrolled between 2011 and 2014. CRT response was defined by echocardiography (15% reduction in left ventricular end-systolic volume) and by cardiopulmonary exercise testing (10% increase in peak oxygen consumption) from baseline to six months after device implantation. ResultsA total of 115 patients were enrolled (68.7% male, mean age 68.6±10.5 years). Echocardiographic response was seen in 51.4% and 59.2% were functional responders. There was no statistical correlation between the two. Functional response was associated with a significantly greater reduction in BNP (-167.6±264.1 vs. -24.9±269.4 pg/ml; p=0.044) and CRP levels (-1.6±4.4 vs. 2.4±9.9 mg/l; p=0.04). Nonetheless, a non-significant reduction in BNP and CRP was observed in echocardiographic responders (BNP -144.7±260.2 vs. -66.1±538.2 pg/ml and CRP -7.1±24.3 vs. 0.8±10.3 mg/l; p>0.05). ConclusionAn increase in exercise capacity after CRT implantation is associated with improvement in myocardial remodeling and inflammatory biomarkers. This finding highlights the importance of improvement in functional capacity after CRT implantation, not commonly considered a criterion of CRT response." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 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" => "IntroduçãoA avaliação da resposta à terapêutica de ressincronização cardíaca (CRT) assenta em critérios clínicos e ecocardiográficos, sem evidência inequívoca que apoie o uso de uns em relação aos outros. Reduções do péptido natriurético tipo-B (BNP) e da proteína C-reactiva (PCR) associaram-se à resposta à CRT. O objetivo deste estudo é avaliar a variação do BNP e PCR após seis meses de CRT e relacionar essa variação com critérios de resposta funcional e ecocardiográfica. MétodosDe 2011 a 2014, doentes com indicação para CRT foram incluídos prospetivamente. A resposta à CRT foi definida por ecocardiograma (redução em 15% no volume telessistólico do ventrículo esquerdo) e por prova cardiorrespiratória (aumento de 10% no consumo de oxigénio máximo), aos seis meses. ResultadosForam incluídos 115 doentes (género masculino: 68,7%, idade média 68,6±10,5 anos); 51,4% apresentaram resposta ecocardiográfica e 59,2% resposta funcional. Não se verificou uma correlação estatisticamente significativa entre esses. Os respondedores funcionais apresentaram reduções estatisticamente significativas de BNP (-167,6±264,1 versus -24,9±269,4; p=0,044) e PCR (-1,6±4,4 versus 2,4±9,9; p=0,04). No grupo de respondedores ecocardiográficos essa redução não atingiu significância estatística [BNP (-144,7±260,2 versus -66,1±538,2) e PCR (-7,1±24,3 versus 0,8±10,3;p>0,05)]. ConclusãoUm aumento da capacidade funcional após implantação de CRT está associado a uma melhoria dos biomarcadores inflamatórios e de remodelagem reversa ventricular. Essa ideia enaltece a importância da melhoria da capacidade funcional após implantação de CRT, pouco considerada como critério de resposta à ressincronização." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 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:2 [ "identificador" => "nom0005" "listaDefinicion" => array:1 [ 0 => array:2 [ "titulo" => "List of abbreviations" "definicion" => array:12 [ 0 => array:2 [ "termino" => "BNP" "descripcion" => "B-type natriuretic peptide" ] 1 => array:2 [ "termino" => "CHF" "descripcion" => "chronic heart failure" ] 2 => array:2 [ "termino" => "CPET" "descripcion" => "cardiopulmonary exercise testing" ] 3 => array:2 [ "termino" => "CRP" "descripcion" => "C-reactive protein" ] 4 => array:2 [ "termino" => "CRT" "descripcion" => "cardiac resynchronization therapy" ] 5 => array:2 [ "termino" => "ICC" "descripcion" => "intraclass correlation coefficient" ] 6 => array:2 [ "termino" => "LVEDV" "descripcion" => "left ventricular end-diastolic volume" ] 7 => array:2 [ "termino" => "LVEF" "descripcion" => "left ventricular ejection fraction" ] 8 => array:2 [ "termino" => "LVESV" "descripcion" => "left ventricular end-systolic volume" ] 9 => array:2 [ "termino" => "NYHA" "descripcion" => "New York Heart Association" ] 10 => array:2 [ "termino" => "VO2 max" "descripcion" => "peak oxygen uptake" ] 11 => array:2 [ "termino" => "VE/VCO2" "descripcion" => "minute ventilation-carbon dioxide production slope" ] ] ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1511 "Ancho" => 2281 "Tamanyo" => 74871 ] ] "descripcion" => array:1 [ "en" => "Correlation between B-type natriuretic peptide (BNP) levels and echocardiographic response to cardiac resynchronization therapy. Response was defined as a ≥15% reduction in left ventricular end-systolic volume (LVESV). Δ BNP: variation in BNP levels." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1539 "Ancho" => 2332 "Tamanyo" => 68284 ] ] "descripcion" => array:1 [ "en" => "Correlation between C-reactive protein (CRP) levels and echocardiographic response to cardiac resynchronization therapy. Response was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV). Δ CRP: variation in CRP levels." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1511 "Ancho" => 2333 "Tamanyo" => 84632 ] ] "descripcion" => array:1 [ "en" => "Correlation between B-type natriuretic peptide (BNP) levels and functional response to cardiac resynchronization therapy. Response was defined as a ≥10% increase in peak oxygen consumption (VO2 max). Δ BNP: variation in BNP levels." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1515 "Ancho" => 2307 "Tamanyo" => 79411 ] ] "descripcion" => array:1 [ "en" => "Correlation between C-reactive protein (CRP) levels and functional response to cardiac resynchronization therapy. Response was defined as a ≥10% increase in peak oxygen consumption (VO2 max). Δ CRP: variation in CRP levels." ] ] 4 => 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" => "ACEIs: angiotensin-converting enzyme inhibitors; AF: atrial fibrillation; ARBs: angiotensin receptor blockers; BNP: B-type natriuretic peptide; CPET: cardiopulmonary exercise test; Cr: creatinine; CRP: C-reactive protein; Hb: hemoglobin; NR: non-responder; LVEDV: left ventricular end-diastolic volume; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume; NYHA: New York Heart Association functional class; R: responder; SD: standard deviation; VE/VCO2: minute ventilation-carbon dioxide production slope; VO2 max: peak oxygen consumption." "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">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LVESV ≤15%</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VO2 max ≥10%</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">R (59) \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">NR (56) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R (68) \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">NR (47) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Demographic</td></tr><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">68.5±14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.5±8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.5±9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.4±10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Clinical</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic etiology (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 II/III/IV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.4/62.9/2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.9/75.0/3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.6/66.7/2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.9/70.4/3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Smoker (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Family history (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Medication</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anticoagulants (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Beta-blockers (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">ACEIs/ARBs (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Diuretics (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Laboratory</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP (mg/l) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.6±24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.1±7.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.55±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">BNP (pg/ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">530.9±528.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">636.0±657.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">520.7±439.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">404.3±485.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Cr (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">1.16±0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.10±0.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.07±0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.15±0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Hb (g/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">12.1±0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.8±0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.9±0.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.3±0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Electrocardiography</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">QRS width (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">172.0±24.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165.8±38.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">166±25.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">176.6±25.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Echocardiography</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">24.8±6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.3 ±7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.6±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.7±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">LVEDV (ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">231.8±69.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">202.4±61.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">225.6±68.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">218.5±84.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">LVESV (ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">173.8±58.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">143.6±59.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165.0±64.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">163.3±68.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">CPET</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2 max (ml/min/kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.1±6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.0±15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.1±4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.6±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \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">VE/VCO2 slope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.9±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.7±37.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.3±11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.2±10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">Duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.63±2.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.8±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.02±1.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.0±2.5 \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></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1702748.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of echocardiographic and functional responders and non-responders." ] ] 5 => 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" => "BNP: B-type natriuretic peptide; CPET: cardiopulmonary exercise testing; CRP: C-reactive protein; LVEDV: left ventricular end-diastolic volume; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume; VE/VCO2: minute ventilation-carbon dioxide production slope; VO2 max: peak oxygen consumption." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">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">Six-month follow-up \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Laboratory</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP (mg/l) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0±15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5±15.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<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">BNP (pg/ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">533.6±553.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">404.9±530.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Electrocardiography</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">QRS width (ms) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">172.1±28.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">169.4±13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Echocardiography</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="char" valign="top">26.4±7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.7±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<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">LVEDV (ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">208.6±69.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">201.3±81.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<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">LVESV (ml) (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158.1±57.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.4±66.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">CPET</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2 max (ml/min/kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.4±4.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<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">VE/VCO2 slope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.0±11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.4±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<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">Duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1702747.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Laboratory, electrocardiographic, echocardiographic and cardiopulmonary exercise test data at baseline and six-month follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy reduces the risk of hospitalizations in patients with advanced heart failure: results from the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.S. Anand" 1 => "P. Carson" 2 => "E. Galle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.793273" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2009" "volumen" => "119" "paginaInicial" => "969" "paginaFinal" => "977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19204305" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0180" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Linde" 1 => "W.T. Abraham" 2 => "M.R. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.08.027" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "1834" "paginaFinal" => "1843" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19038680" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0185" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: cardiac resynchronization in patients with symptomatic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.A. McAlister" 1 => "J.A. Ezekowitz" 2 => "N. Wiebe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2004" "volumen" => "141" "paginaInicial" => "381" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15353430" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0190" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Wells" 1 => "R. Parkash" 2 => "J.S. Healey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "2011" "volumen" => "183" "paginaInicial" => "421" "paginaFinal" => "429" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0195" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of cardiac resynchronization therapy on reverse remodeling and relation to outcome: multicenter automatic defibrillator implantation trial: cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.D. Solomon" 1 => "E. Foster" 2 => "M. Bourgoun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.955039" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "122" "paginaInicial" => "985" "paginaFinal" => "992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20733097" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0200" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, definition, diagnosis, and management of the cardiac resynchronization therapy nonresponder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Q. Zhang" 1 => "Y. Zhou" 2 => "C.-M. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/HCO.0000000000000140" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Cardiol" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "40" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25469590" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0205" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug and device effects on peak oxygen consumption, 6-minute walk distance, and natriuretic peptides as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.S. Wessler" 1 => "D.G. Kramer" 2 => "J.L. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.111.961573" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "578" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21705485" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0210" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of cardiac resynchronization therapy on exercise performance, functional capacity, and quality of life in systolic heart failure with QRS prolongation: COMPANION trial sub-study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. De Marco" 1 => "E. Wolfel" 2 => "A.M. Feldman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2007.08.003" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "9" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18226768" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0215" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy improves minute ventilation/carbon dioxide production slope and skeletal muscle capillary density without reversal of skeletal muscle pathology or inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.I. Larsen" 1 => "S. Lindal" 2 => "K. Myreng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eus428" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "857" "paginaFinal" => "864" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23322010" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0220" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Agreement is poor among current criteria used to define response to cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.K. Fornwalt" 1 => "W.W. Sprague" 2 => "P. BeDell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.910778" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "121" "paginaInicial" => "1985" "paginaFinal" => "1991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20421518" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0225" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between brain natriuretic peptide, markers of inflammation and the objective and subjective response to cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Brouwers" 1 => "H. Versteeg" 2 => "M. Meine" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbi.2014.03.017" "Revista" => array:6 [ "tituloSerie" => "Brain Behav Immun" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "211" "paginaFinal" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24704567" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0230" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurohormonal and inflammatory markers as predictors of short-term outcome in patients with heart failure and cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Glick" 1 => "Y. Michowitz" 2 => "G. Keren" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Isr Med Assoc J" "fecha" => "2006" "volumen" => "8" "paginaInicial" => "391" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16833167" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0235" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of cardiac resynchronization therapy on systemic inflammation and neurohormonal pathways in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Tarquini" 1 => "C.T. Guerra" 2 => "M.C. Porciani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cardiol J" "fecha" => "2009" "volumen" => "16" "paginaInicial" => "545" "paginaFinal" => "552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19950091" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0240" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy – clinical and echocardiographic characteristics of responders and exceptional responders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Galrinho" 1 => "L.M. Branco" 2 => "M.M. Oliveira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "959" "paginaFinal" => "969" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19998807" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0245" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.P. Araújo" 1 => "P. Lourenço" 2 => "A. Azevedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2008.10.030" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "256" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19327628" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0250" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High sensitivity C-reactive protein predicts nonresponders and cardiac deaths in severe heart failure patients after CRT implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Kamioka" 1 => "H. Suzuki" 2 => "S. Yamada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Heart J" "fecha" => "2012" "volumen" => "53" "paginaInicial" => "306" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23038092" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0255" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated C-reactive protein in acute coronary syndrome presentation is an independent predictor of long-term mortality and heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Kavsak" 1 => "A.R. MacRae" 2 => "A.M. Newman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinbiochem.2006.10.025" "Revista" => array:6 [ "tituloSerie" => "Clin Biochem" "fecha" => "2007" "volumen" => "40" "paginaInicial" => "326" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17292342" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0335" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "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)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Developed in collaboration with the European Heart Rhythm Association (EHRA)" "etal" => false ] ] ] ] "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" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0260" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.B. Schiller" 1 => "P.M. Shah" 2 => "M. Crawford" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "1989" "volumen" => "2" "paginaInicial" => "358" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2698218" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0265" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is treatment success in cardiac resynchronization therapy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.W.X. Foley" 1 => "F. Leyva" 2 => "M.P. Frenneaux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eup308" "Revista" => array:7 [ "tituloSerie" => "Europace" "fecha" => "2009" "volumen" => "11" "numero" => "Suppl. 5" "paginaInicial" => "v58" "paginaFinal" => "v65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19861392" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0270" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Which echocardiographic definition should be used to define response to cardiac resynchronization therapy?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. António" 1 => "R. Teixeira" 2 => "C. Lourenço" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "943" "paginaFinal" => "958" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19998806" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0275" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.G. Balci" 1 => "M.M. Balci" 2 => "F. Sen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5603/KP.a2015.0142" "Revista" => array:6 [ "tituloSerie" => "Kardiol Pol" "fecha" => "2016" "volumen" => "74" "paginaInicial" => "119" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26202536" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0280" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiinflammatory effects of cardiac resynchronization therapy in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.N. Theodorakis" 1 => "P. Flevari" 2 => "C. Kroupis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8159.2006.00331.x" "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "255" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16606392" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0285" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical, echocardiographic, and neurohormonal response to cardiac resynchronization therapy: are they interchangeable?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.E. Hoogslag" 1 => "U. Höke" 2 => "J. Thijssen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pace.12214" "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "1391" "paginaFinal" => "1401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23826659" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0290" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.M. Yu" 1 => "G.B. Bleeker" 2 => "Fung JW-H" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.105.538272" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "1580" "paginaFinal" => "1586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16144994" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0295" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reverse cardiac remodeling: a marker of better prognosis in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.R. de A.R. Reis" 1 => "J.N. Cardoso" 2 => "C.M. dos R. Cardoso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5935/abc.20150025" "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2015" "volumen" => "104" "paginaInicial" => "502" "paginaFinal" => "506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26131706" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0300" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of clinical and echocardiographic response to cardiac resynchronization therapy on long-term survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Bertini" 1 => "U. Höke" 2 => "R.J. van Bommel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ehjci/jes290" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J Cardiovasc Imaging" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "774" "paginaFinal" => "781" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23221312" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0305" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of cardiac resynchronization therapy response" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Cattadori" 1 => "F. Giraldi" 2 => "M. Berti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2008.04.052" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2009" "volumen" => "136" "paginaInicial" => "240" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18672300" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0310" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-inflammatory effect of cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.T. Lappegård" 1 => "H. Bjørnstad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8159.2006.00430.x" "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "753" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16884512" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0315" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of mortality in chronic heart failure from peak oxygen consumption adjusted for either body weight or lean tissue" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Cicoira" 1 => "C.H. Davos" 2 => "D.P. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2004" "volumen" => "10" "paginaInicial" => "421" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15470653" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0320" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates – 2006" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Mehra" 1 => "J. Kobashigawa" 2 => "R. Starling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2006.06.008" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "1024" "paginaFinal" => "1042" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16962464" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0325" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic impact of peakVO2-changes in stable CHF on chronic beta-blocker treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Frankenstein" 1 => "M. Nelles" 2 => "M. Hallerbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2006.11.038" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2007" "volumen" => "122" "paginaInicial" => "125" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17222927" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0330" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory activation following interruption of long-term cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Rubaj" 1 => "P. Ruciński" 2 => "K. Oleszczak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00380-012-0285-y" "Revista" => array:6 [ "tituloSerie" => "Heart Vessels" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "583" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23242167" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300588/v1_201803200458/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000002/v1_201803200458/S2174204918300588/v1_201803200458/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300588?idApp=UINPBA00004E"]

Statistics

Original Article

Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response

Impacto da ressincronização cardíaca nos biomarcadores inflamatórios e de remodelagem cardíaca

Luís Almeida-Morais

Corresponding author

lmmorais88@gmail.com

Corresponding author.

, Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Inês Rodrigues, Guilherme Portugal, Pedro Rio, Rui Soares, Miguel Mota Carmo, Rui Cruz Ferreira

Centro Universitário de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal

Read

4628

Times
was read the article

1614

Total PDF

3014

Total HTML

Share statistics

 array:24 [
  "pii" => "S2174204918300588"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2018.03.007"
  "estado" => "S300"
  "fechaPublicacion" => "2018-02-01"
  "aid" => "1148"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2018;37:105-13"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1305
    "formatos" => array:3 [
      "EPUB" => 156
      "HTML" => 914
      "PDF" => 235
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204918300096"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2018.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2018-02-01"
    "aid" => "1151"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2018;37:115-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1629
      "formatos" => array:3 [
        "EPUB" => 145
        "HTML" => 1164
        "PDF" => 320
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Reduction of systemic inflammation after cardiac resynchronization therapy&#58; A new form of response&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "115"
          "paginaFinal" => "116"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Redu&#231;&#227;o da inflama&#231;&#227;o sist&#233;mica ap&#243;s terap&#234;utica de ressincroniza&#231;&#227;o card&#237;aca&#58; uma nova forma de resposta&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nat&#225;lia Ant&#243;nio"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Nat&#225;lia"
              "apellidos" => "Ant&#243;nio"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255118300350"
        "doi" => "10.1016/j.repc.2018.01.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118300350?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300096?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300096/v1_201803200458/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204918300138"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2017.11.017"
    "estado" => "S300"
    "fechaPublicacion" => "2018-02-01"
    "aid" => "1142"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2018;37:97-104"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1948
      "formatos" => array:3 [
        "EPUB" => 132
        "HTML" => 1406
        "PDF" => 410
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Perspectives in Cardiology</span>"
      "titulo" => "Heart failure in numbers&#58; Estimates for the 21st century in Portugal"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "97"
          "paginaFinal" => "104"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Insufici&#234;ncia card&#237;aca em n&#250;meros&#58; estimativas para o s&#233;culo XXI em Portugal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 1259
              "Ancho" => 2331
              "Tamanyo" => 140012
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estimated changes in numbers of patients with heart failure in mainland Portugal&#44; by age group&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#226;ndida Fonseca, Daniel Br&#225;s, In&#234;s Ara&#250;jo, F&#225;tima Ceia"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "C&#226;ndida"
              "apellidos" => "Fonseca"
            ]
            1 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Br&#225;s"
            ]
            2 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Ara&#250;jo"
            ]
            3 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Ceia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S087025511730745X"
        "doi" => "10.1016/j.repc.2017.11.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730745X?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300138?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300138/v1_201803200458/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling&#58; The paradox of functional and echocardiographic response"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "105"
        "paginaFinal" => "113"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Lu&#237;s Almeida-Morais, Ana Abreu, M&#225;rio Oliveira, Pedro Silva Cunha, In&#234;s Rodrigues, Guilherme Portugal, Pedro Rio, Rui Soares, Miguel Mota Carmo, Rui Cruz Ferreira"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "Lu&#237;s"
            "apellidos" => "Almeida-Morais"
            "email" => array:1 [
              0 => "lmmorais88&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Ana"
            "apellidos" => "Abreu"
          ]
          2 => array:2 [
            "nombre" => "M&#225;rio"
            "apellidos" => "Oliveira"
          ]
          3 => array:2 [
            "nombre" => "Pedro"
            "apellidos" => "Silva Cunha"
          ]
          4 => array:2 [
            "nombre" => "In&#234;s"
            "apellidos" => "Rodrigues"
          ]
          5 => array:2 [
            "nombre" => "Guilherme"
            "apellidos" => "Portugal"
          ]
          6 => array:2 [
            "nombre" => "Pedro"
            "apellidos" => "Rio"
          ]
          7 => array:2 [
            "nombre" => "Rui"
            "apellidos" => "Soares"
          ]
          8 => array:2 [
            "nombre" => "Miguel"
            "apellidos" => "Mota Carmo"
          ]
          9 => array:2 [
            "nombre" => "Rui"
            "apellidos" => "Cruz Ferreira"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Centro Universit&#225;rio de Cardiologia&#44; Hospital de Santa Marta&#44; Centro Hospitalar de Lisboa Central&#44; Lisbon&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Impacto da ressincroniza&#231;&#227;o card&#237;aca nos biomarcadores inflamat&#243;rios e de remodelagem card&#237;aca"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1515
            "Ancho" => 2307
            "Tamanyo" => 79411
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Correlation between C-reactive protein &#40;CRP&#41; levels and functional response to cardiac resynchronization therapy&#46; Response was defined as a &#8805;10&#37; increase in peak oxygen consumption &#40;VO<span class="elsevierStyleInf">2</span> max&#41;&#46; &#916; CRP&#58; variation in CRP levels&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0065" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy &#40;CRT&#41; is an established treatment for patients with symptomatic chronic heart failure &#40;CHF&#41; and prolonged QRS despite optimal pharmacological therapy&#46; By restoring the heart&#39;s electromechanical synchrony&#44; CRT improves self-reported symptoms and reduces mortality and rehospitalization for heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;4</span></a> Response to CRT is associated with left ventricular reverse remodeling&#44; which is objectively assessed through echocardiographic parameters&#44; particularly improvement in left ventricular ejection fraction &#40;LVEF&#41; and reduction in left ventricular end-systolic volume &#40;LVESV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> Nonetheless&#44; up to 40&#37; of CRT recipients are considered non-responders&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a> Improvement in New York Heart Association &#40;NYHA&#41; functional class and six-minute walk test distance have also been proposed as clinical response criteria in several studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#44;8</span></a> Improvement in peak oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span> max&#41;&#44; a marker of functional status and activity&#44; has been described after CRT device implantation in a small cohort of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> However&#44; there is little agreement between the criteria of response&#44; which suggests that clinical or functional improvement can occur without changes in echocardiographic parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">B-type natriuretic peptide &#40;BNP&#41; is a marker of volume and pressure overload that has been proposed as a diagnostic and prognostic tool in CHF&#44; in which it correlates well with severity&#46; Moreover&#44; pharmacological therapies that improve CHF symptoms and outcomes have been shown to reduce BNP levels&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> Studies have also reported significant reductions in plasma BNP levels after CRT device implantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#8211;14</span></a> Systemic inflammation is also known to play a role in CHF&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a> and increased serum levels of inflammatory markers such as C-reactive protein &#40;CRP&#41; confer a dismal prognosis for CHF patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Nonetheless&#44; there are conflicting data concerning reductions in BNP and CRP as markers of neurohormonal and inflammatory status after CRT device implantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;12</span></a> Moreover&#44; their association with CRT response criteria that assess different pathological pathways of the syndrome is not fully understood&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Hence&#44; this study aims primarily to assess variations in BNP and CRP six months after CRT device implantation&#44; and secondarily to assess the association between changes in these laboratory variables and functional and echocardiographic response to CRT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population and study design</span><p id="par0085" class="elsevierStylePara elsevierViewall">Between April 2011 and December 2014&#44; consecutive patients referred for CRT device implantation in a tertiary center were systematically included in a prospective cohort study&#46; Indications for CRT followed current international guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">18</span></a> All patients had been on optimal medical therapy for at least six months and were followed by a specialized heart failure team&#46; A comprehensive assessment including demographic&#44; clinical&#44; laboratory&#44; electrocardiographic&#44; echocardiographic and cardiopulmonary exercise testing &#40;CPET&#41; was performed and data were collected at baseline and six months after device implantation and subsequently analyzed&#46; The ethics committee of our university hospital center approved the study protocol and written consent was obtained for all patients&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Demographic and clinical data</span><p id="par0090" class="elsevierStylePara elsevierViewall">Demographic and clinical data were obtained through medical consultation at baseline and at six-month follow-up&#46; Demographic variables included age and gender&#46; Clinical variables included heart failure etiology&#44; classical cardiovascular risk factors&#44; comorbidities&#44; ongoing medication and NYHA functional class&#46; A 12-lead electrocardiogram was also obtained to determine heart rhythm&#44; QRS width and intraventricular conduction pattern&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Laboratory data</span><p id="par0095" class="elsevierStylePara elsevierViewall">Blood samples were collected through peripheral venous catheterization into blood collection tubes with &#40;serum&#41; or without &#40;plasma&#41; anticoagulant &#40;EDTA&#41;&#46; All laboratory tests were performed after at least six hours fasting and at rest in a supine position in the same laboratory using hospital protocol&#44; and assays were determined according to the manufacturer&#39;s recommendations&#46; BNP was analyzed from plasma on a Spinchron DLX 800 &#40;Beckman Coulter&#41; centrifuge using a two-step chemiluminescence assay and serum CRP was determined with a nephelometer &#40;Siemens BN ProSpecT&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Transthoracic echocardiography</span><p id="par0100" class="elsevierStylePara elsevierViewall">A complete transthoracic echocardiogram was performed in all patients using a Vivid E9 scanner &#40;GE Healthcare&#41; with a 3 MHz probe&#44; at baseline and at six-month follow-up&#46; M-mode&#44; two-dimensional&#44; color&#44; pulsed&#44; continuous wave and tissue Doppler data were obtained from parasternal and apical views&#44; and the standard echocardiographic parameters were calculated&#46; Acquired cine-loop images with at least three cardiac cycles were analyzed offline &#40;EchoPAC software&#44; GE Healthcare&#41; for additional measures&#46; LVEF&#44; LVESV and left ventricular end-diastolic volume &#40;LVEDV&#41; were determined from apical 4- and 2-chamber views using Simpson&#39;s biplane method&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> The mean of three measurements was considered for analysis&#46; Endocardial borders were manually traced and the left ventricular papillary muscles were included in volume acquisition&#46; All measurements were reviewed by the same echocardiographic operator&#46; The intraclass correlation coefficient &#40;ICC&#41; was calculated for LVESV to assess intraobserver variability&#46; Echocardiographic response to CRT was established as a &#8805;15&#37; reduction in LVESV from baseline to six months after CRT device implantation&#44; as previously published&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cardiopulmonary exercise testing</span><p id="par0105" class="elsevierStylePara elsevierViewall">CPET with ventilatory expired gas analysis was performed in all patients at baseline and at six-month follow-up using the modified Bruce protocol&#46; Exercise test duration&#44; VO<span class="elsevierStyleInf">2</span> max and minute ventilation-carbon dioxide production slope &#40;VE&#47;VCO<span class="elsevierStyleInf">2</span>&#41; were determined&#46; A significant functional response to CRT was defined as a &#8805;10&#37; increase in VO<span class="elsevierStyleInf">2</span> max from baseline to six-month follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Cardiac resynchronization therapy device implantation</span><p id="par0110" class="elsevierStylePara elsevierViewall">CRT device implantation was performed through a transvenous approach&#44; using the subclavian and cephalic veins&#46; The right atrial lead was positioned in the right atrial appendage and the right ventricular lead was actively fixed in the right ventricular apex or interventricular septum&#46; The left ventricular lead was introduced using a long guiding sheath in order to cannulate the coronary sinus&#46; An angiogram was performed and then the lead was positioned preferably in a lateral or posterolateral vein&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">Baseline demographic and clinical data were expressed as means and standard deviation for continuous variables and as percentages for categorical variables&#46; Changes in BNP and CRP &#40;&#916; BNP and &#916; CRP&#41; were established by the arithmetic subtraction of their values at six-month follow-up from baseline&#46; Normality &#40;Gaussian distribution&#41; was tested in all continuous variables using the Shapiro-Wilk test&#46; To assess the association between continuous variables&#44; Pearson&#39;s or Spearman&#39;s correlation was used for normally or non-normally distributed data&#44; respectively&#46; &#916; BNP and &#916; CRP were separately compared between echocardiographic and functional responders and non-responders using the Student&#39;s t or Mann-Whitney tests for normally or non-normally distributed variables&#44; respectively&#46; The chi-square test was used to compare dichotomous variables&#46; The level of significance considered was &#945;&#61;0&#46;05&#46; Data were analyzed using SPSS for Windows&#44; version 20&#46;0 &#40;IBM SPSS Inc&#44; Chicago&#44; IL&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Baseline characteristics</span><p id="par0120" class="elsevierStylePara elsevierViewall">A total of 115 patients underwent CRT device implantation for whom complete data were collected at baseline and six-month follow-up&#46; Mean age was 68&#46;6&#177;10&#46;5 years and 68&#46;7&#37; were male&#46; Ischemic heart failure etiology was reported in 29&#46;1&#37;&#46; Mean QRS width at baseline was 172&#46;1&#177;28&#46;8 ms and complete left bundle branch block was present in 56&#37; of patients&#46; Beta-blockers were prescribed in 86&#46;2&#37; of patients and 88&#46;6&#37; were treated with renin-angiotensin system inhibitors &#40;angiotensin-converting enzyme inhibitors or angiotensin receptor blockers&#41;&#46; At baseline&#44; 74&#46;3&#37; patients were in NYHA functional class III or IV&#46; Clinical improvement of at least one NYHA class was observed in 81&#46;3&#37; of patients&#46; CRP and BNP presented a statistically significant reduction from baseline to six-month follow-up &#40;CRP 7&#46;0&#177;15&#46;6 to 6&#46;5&#177;15&#46;3 mg&#47;l&#44; p&#60;0&#46;001&#44; and BNP 533&#46;6&#177;553&#46;6 to 404&#46;9&#177;530&#46;3 pg&#47;ml&#44; p&#60;0&#46;001&#41;&#46; Echocardiographic response was observed in 51&#46;4&#37; and functional response in 59&#46;2&#37;&#44; assessed by the above criteria&#46; Response as assessed by echocardiography was not statistically correlated with functional response &#40;r&#61;0&#46;14&#44; p&#61;0&#46;433 and chi-square&#61;0&#46;063&#44; p&#61;0&#46;80&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> delineates the baseline demographic and clinical characteristics of responders and non-responders assessed by both sets of criteria independently&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> details laboratory&#44; echocardiographic and CPET data at baseline and at six-month follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Echocardiographic response</span><p id="par0130" class="elsevierStylePara elsevierViewall">In our cohort&#44; severely reduced mean LVEF at baseline was observed &#40;26&#46;4&#177;7&#46;0&#37;&#41;&#46; A significant improvement in mean LVEF and reduction in mean LVEDV and LVESV were noted after CRT device implantation&#46; Additionally&#44; 63&#46;4&#37; of patients showed more than 10&#37; improvement in LVEF and in 51&#46;4&#37; of patients LVESV decreased by more than 15&#37; compared to baseline &#40;echocardiographic responders&#41;&#46; An ICC of 0&#46;89 at baseline and 0&#46;87 at six-month follow-up was calculated for intraobserver variability of LVESV&#46; BNP reduction was more pronounced in responders than in non-responders as assessed by echocardiography&#44; although this did not achieve statistical significance &#40;-144&#46;7&#177;260&#46;2 vs&#46; -66&#46;1&#177;538&#46;2 pg&#47;ml&#44; p&#62;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Echocardiographic responders also presented a non-significant reduction in serum CRP levels after CRT &#40;-7&#46;1&#177;24&#46;3 vs&#46; 0&#46;7&#177;10&#46;3 mg&#47;l&#44; p&#62;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Functional response</span><p id="par0135" class="elsevierStylePara elsevierViewall">VO<span class="elsevierStyleInf">2</span> max during CPET was severely depressed at baseline &#40;mean 14&#46;5&#177;5&#46;2 ml&#47;min&#47;kg&#41;&#46; However&#44; a statistically significant improvement &#40;14&#46;5&#177;5&#46;2 to 16&#46;4&#177;4&#46;1 ml&#47;min&#47;kg&#44; p&#60;0&#46;001&#41; was observed after CRT device implantation&#46; Improvement in exercise capacity was also shown by a significant reduction in VE&#47;VCO<span class="elsevierStyleInf">2</span> slope and longer CPET duration &#40;38&#46;0&#177;11&#46;6 vs&#46; 32&#46;4&#177;7&#46;1 and 3&#46;7&#177;2&#46;4 vs&#46; 4&#46;7&#177;2&#46;2 ms&#44; respectively&#44; all p&#60;0&#46;001&#41; at six-month follow-up&#46; BNP reduction was significantly more pronounced in those classified as functional responders &#40;-167&#46;6&#177;264&#46;1 pg&#47;ml vs&#46; -24&#46;9&#177;269&#46;4 pg&#47;ml&#44; p&#61;0&#46;044&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; CRP reduction was seen in functional responders&#44; while non-responders presented elevation in mean CRP levels six months after CRT device implantation &#40;-1&#46;6&#177;4&#46;4 vs&#46; 2&#46;4&#177;9&#46;9 mg&#47;l&#44; p&#61;0&#46;040&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46; A significant reduction in VE&#47;VCO<span class="elsevierStyleInf">2</span> slope was also noted in functional responders &#40;-9&#46;8&#177;10&#46;5 vs&#46; 1&#46;9&#177;7&#46;2&#44; p&#61;0&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In our study population a significant reduction of CRP and BNP was observed six months after CRT &#40;CRP 7&#46;0&#177;15&#46;6 to 6&#46;5&#177;15&#46;3 mg&#47;l&#44; p&#60;0&#46;001 and BNP 533&#46;6&#177;553&#46;6 to 404&#46;9&#177;530&#46;3 pg&#47;ml&#44; p&#60;0&#46;001&#41;&#46; The CRP and BNP reductions were significantly higher in the functional responder group&#44; whereas they did not achieve statistical significance in the echocardiographic responder group&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Heart failure is a systemic condition with increased levels of natriuretic peptides and inflammatory markers&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;13</span></a> Therapies targeting these pathways have shown positive prognostic impact in this syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">As described&#44; our cohort represents a severe heart failure population characterized by poor self-reported functional status&#44; reduced exercise capacity and low mean LVEF&#46; Moreover&#44; compared to other studies&#44; our population presented a higher proportion of nonischemic heart failure etiology&#44; such as idiopathic&#44; valvular and alcoholic&#44; only 29&#46;1&#37; of patients having ischemic heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">18</span></a> The heart failure etiology did not significantly differ between functional or echocardiographic responders and non-responders&#46; Patients in our population presented advanced age&#44; which excludes them from a heart transplantation program&#44; and they were already on optimal medical therapy&#46; Additionally&#44; the high mean BNP and CRP levels presented at baseline support the concept of an advanced heart failure population&#44; and significant reductions in BNP and CRP levels were observed at six-month follow-up after CRT device implantation&#44; which is in line with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">22&#8211;24&#44;12</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Response to CRT is the subject of considerable debate&#44; since there is no established definition for therapeutic response&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> Improvement in LVEF and reductions in LVESV and LVEDV are the result of left ventricular reverse remodeling&#46; Pharmacological therapies targeting this effect have been shown to be associated with better long-term outcomes in heart failure patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#8211;28</span></a> The cut-off of a &#8805;15&#37; reduction in LVESV has been described as a more specific surrogate of left ventricular reverse remodeling than LVEF&#44; and has been used to define those responding to CRT therapy by echocardiography&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;11&#44;14&#44;21</span></a> In our study&#44; only 51&#46;4&#37; of patients achieved this demanding criterion at six months&#46; These echocardiographic responders had a more pronounced reduction in BNP at six-month follow-up than non-responders&#44; but this did not achieve statistical significance&#46; Despite targeting the same mechanism&#44; the demanding cut-off for LVESV reduction&#44; the short follow-up time for structural changes and variability in BNP could explain this phenomenon&#46; Regarding the changes in CRP&#44; a widely used marker of systemic inflammation&#44; there was no significant association with reduced LVESV&#44; perhaps because they reflect different pathways of the pathological disease process&#46; The association reported in the literature between reduced LVESV and changes in BNP or CRP after CRT has in fact been variable&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14&#44;28&#44;29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Exercise capacity&#44; measured through VO<span class="elsevierStyleInf">2</span> max during CPET&#44; is known to be a major prognostic indicator in heart failure patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">30&#44;31</span></a> It has been assessed in conjunction with pharmacological therapies for heart failure patients&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> However&#44; its use for determining functional response after CRT is not routinely considered and lacks clinical evidence&#46; We used a cut-off of &#8805;10&#37; improvement in VO<span class="elsevierStyleInf">2</span> max to define functional responders&#44; and our study revealed significantly greater reductions in BNP and CRP among CRT patients in whom VO<span class="elsevierStyleInf">2</span> max improved substantially at six-month follow-up&#46; An association between reductions in neurohormonal and inflammatory levels and a &#8805;10&#37; improvement in VO<span class="elsevierStyleInf">2</span> max has not previously been reported in this population&#46; Volume overload in heart failure is responsible for raised left ventricular and atrial pressure and consequently elevation of pulmonary capillary wedge pressure&#44; which is associated with functional exercise impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> Moreover&#44; systemic inflammatory markers increase oxygen demand&#44; depress myocardial function and disturb homeostasis in the pulmonary vasculature&#44; influencing the interaction between heart and lungs&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a> This finding suggests that electromechanical resynchronization may have a role in reversing these pathological processes&#44; which highlights the importance of considering improvement in VO<span class="elsevierStyleInf">2</span> max after CRT as a response criterion&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In our study&#44; the association between reduced LVESV and improved VO<span class="elsevierStyleInf">2</span> max was non-significant&#44; suggesting that those who improved by one criterion may not have improved by the other&#46; Similarly&#44; Fornwalt et al&#46; showed that agreement between criteria of clinical&#44; echocardiographic and functional exercise response after CRT device implantation is poor&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> indicating that CRT may lead to improvements in different parameters in different patients&#46; Functional response supported by reduction in BNP and CRP could be related to CRT response independently of significant left ventricular reverse remodeling at six-month follow-up&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Study limitations</span><p id="par0170" class="elsevierStylePara elsevierViewall">Follow-up time in this study was set at six months after CRT implantation&#44; which may be insufficient to assess the long-term structural changes of left ventricular reverse remodeling&#46; Moreover&#44; inferences cannot be made about the lasting clinical&#44; laboratory or echocardiographic alterations in this population after this time&#46; Additionally&#44; CRP levels are susceptible to variability&#44; and ongoing inflammatory processes that influenced CRP levels cannot be excluded&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">CRT was associated with important reductions in BNP and CRP levels at six-month follow-up&#46; Patients presenting significantly improved functional capacity&#44; considered functional responders&#44; showed significant reductions in serum BNP and CRP levels at six-month follow-up&#44; reflecting its benefit on ventricular remodeling and inflammation&#46; In echocardiographic responders this effect was smaller and non-significant&#44; which calls attention to the importance of assessing functional response in CRT patients&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1005646"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            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" => "xpalclavsec965433"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1005645"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec965434"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Population and study design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Demographic and clinical data"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Laboratory data"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Transthoracic echocardiography"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Cardiopulmonary exercise testing"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Cardiac resynchronization therapy device implantation"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Baseline characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Echocardiographic response"
            ]
            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Functional response"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Study limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conclusion"
        ]
        10 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-01"
    "fechaAceptado" => "2017-06-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec965433"
          "palabras" => array:4 [
            0 => "Heart failure"
            1 => "Cardiac resynchronization therapy"
            2 => "B-type natriuretic peptide"
            3 => "C-reactive protein"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec965434"
          "palabras" => array:4 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Terapia de ressincroniza&#231;&#227;o card&#237;aca"
            2 => "P&#233;ptido natriur&#233;tico tipo-B"
            3 => "Prote&#237;na C-reactiva"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Response to cardiac resynchronization therapy &#40;CRT&#41; can currently be assessed by clinical or echocardiographic criteria&#44; and there is no strong evidence supporting the use of one rather than the other&#46; Reductions in B-type natriuretic peptide &#40;BNP&#41; and C-reactive protein &#40;CRP&#41; have been shown to be associated with CRT response&#46; This study aims to assess variation in BNP and CRP six months after CRT and to correlate this variation with criteria of functional and echocardiographic response&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients undergoing CRT were prospectively enrolled between 2011 and 2014&#46; CRT response was defined by echocardiography &#40;15&#37; reduction in left ventricular end-systolic volume&#41; and by cardiopulmonary exercise testing &#40;10&#37; increase in peak oxygen consumption&#41; from baseline to six months after device implantation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 115 patients were enrolled &#40;68&#46;7&#37; male&#44; mean age 68&#46;6&#177;10&#46;5 years&#41;&#46; Echocardiographic response was seen in 51&#46;4&#37; and 59&#46;2&#37; were functional responders&#46; There was no statistical correlation between the two&#46; Functional response was associated with a significantly greater reduction in BNP &#40;-167&#46;6&#177;264&#46;1 vs&#46; -24&#46;9&#177;269&#46;4 pg&#47;ml&#59; p&#61;0&#46;044&#41; and CRP levels &#40;-1&#46;6&#177;4&#46;4 vs&#46; 2&#46;4&#177;9&#46;9 mg&#47;l&#59; p&#61;0&#46;04&#41;&#46; Nonetheless&#44; a non-significant reduction in BNP and CRP was observed in echocardiographic responders &#40;BNP -144&#46;7&#177;260&#46;2 vs&#46; -66&#46;1&#177;538&#46;2 pg&#47;ml and CRP -7&#46;1&#177;24&#46;3 vs&#46; 0&#46;8&#177;10&#46;3 mg&#47;l&#59; p&#62;0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An increase in exercise capacity after CRT implantation is associated with improvement in myocardial remodeling and inflammatory biomarkers&#46; This finding highlights the importance of improvement in functional capacity after CRT implantation&#44; not commonly considered a criterion of CRT response&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          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" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A avalia&#231;&#227;o da resposta &#224; terap&#234;utica de ressincroniza&#231;&#227;o card&#237;aca &#40;CRT&#41; assenta em crit&#233;rios cl&#237;nicos e ecocardiogr&#225;ficos&#44; sem evid&#234;ncia inequ&#237;voca que apoie o uso de uns em rela&#231;&#227;o aos outros&#46; Redu&#231;&#245;es do p&#233;ptido natriur&#233;tico tipo-B &#40;BNP&#41; e da prote&#237;na C-reactiva &#40;PCR&#41; associaram-se &#224; resposta &#224; CRT&#46; O objetivo deste estudo &#233; avaliar a varia&#231;&#227;o do BNP e PCR ap&#243;s seis meses de CRT e relacionar essa varia&#231;&#227;o com crit&#233;rios de resposta funcional e ecocardiogr&#225;fica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De 2011 a 2014&#44; doentes com indica&#231;&#227;o para CRT foram inclu&#237;dos prospetivamente&#46; A resposta &#224; CRT foi definida por ecocardiograma &#40;redu&#231;&#227;o em 15&#37; no volume telessist&#243;lico do ventr&#237;culo esquerdo&#41; e por prova cardiorrespirat&#243;ria &#40;aumento de 10&#37; no consumo de oxig&#233;nio m&#225;ximo&#41;&#44; aos seis meses&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 115 doentes &#40;g&#233;nero masculino&#58; 68&#44;7&#37;&#44; idade m&#233;dia 68&#44;6&#177;10&#44;5 anos&#41;&#59; 51&#44;4&#37; apresentaram resposta ecocardiogr&#225;fica e 59&#44;2&#37; resposta funcional&#46; N&#227;o se verificou uma correla&#231;&#227;o estatisticamente significativa entre esses&#46; Os respondedores funcionais apresentaram redu&#231;&#245;es estatisticamente significativas de BNP &#40;-167&#44;6&#177;264&#44;1 <span class="elsevierStyleItalic">versus</span> -24&#44;9&#177;269&#44;4&#59; p&#61;0&#44;044&#41; e PCR &#40;-1&#44;6&#177;4&#44;4 <span class="elsevierStyleItalic">versus</span> 2&#44;4&#177;9&#44;9&#59; p&#61;0&#44;04&#41;&#46; No grupo de respondedores ecocardiogr&#225;ficos essa redu&#231;&#227;o n&#227;o atingiu signific&#226;ncia estat&#237;stica &#91;BNP &#40;-144&#44;7&#177;260&#44;2 <span class="elsevierStyleItalic">versus</span> -66&#44;1&#177;538&#44;2&#41; e PCR &#40;-7&#44;1&#177;24&#44;3 <span class="elsevierStyleItalic">versus</span> 0&#44;8&#177;10&#44;3&#59;p&#62;0&#44;05&#41;&#93;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Um aumento da capacidade funcional ap&#243;s implanta&#231;&#227;o de CRT est&#225; associado a uma melhoria dos biomarcadores inflamat&#243;rios e de remodelagem reversa ventricular&#46; Essa ideia enaltece a import&#226;ncia da melhoria da capacidade funcional ap&#243;s implanta&#231;&#227;o de CRT&#44; pouco considerada como crit&#233;rio de resposta &#224; ressincroniza&#231;&#227;o&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:2 [
        "identificador" => "nom0005"
        "listaDefinicion" => array:1 [
          0 => array:2 [
            "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
            "definicion" => array:12 [
              0 => array:2 [
                "termino" => "BNP"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">B-type natriuretic peptide</p>"
              ]
              1 => array:2 [
                "termino" => "CHF"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">chronic heart failure</p>"
              ]
              2 => array:2 [
                "termino" => "CPET"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiopulmonary exercise testing</p>"
              ]
              3 => array:2 [
                "termino" => "CRP"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">C-reactive protein</p>"
              ]
              4 => array:2 [
                "termino" => "CRT"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiac resynchronization therapy</p>"
              ]
              5 => array:2 [
                "termino" => "ICC"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">intraclass correlation coefficient</p>"
              ]
              6 => array:2 [
                "termino" => "LVEDV"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">left ventricular end-diastolic volume</p>"
              ]
              7 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              8 => array:2 [
                "termino" => "LVESV"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">left ventricular end-systolic volume</p>"
              ]
              9 => array:2 [
                "termino" => "NYHA"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">New York Heart Association</p>"
              ]
              10 => array:2 [
                "termino" => "VO<span class="elsevierStyleInf">2</span> max"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">peak oxygen uptake</p>"
              ]
              11 => array:2 [
                "termino" => "VE&#47;VCO<span class="elsevierStyleInf">2</span>"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">minute ventilation-carbon dioxide production slope</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1511
            "Ancho" => 2281
            "Tamanyo" => 74871
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Correlation between B-type natriuretic peptide &#40;BNP&#41; levels and echocardiographic response to cardiac resynchronization therapy&#46; Response was defined as a &#8805;15&#37; reduction in left ventricular end-systolic volume &#40;LVESV&#41;&#46; &#916; BNP&#58; variation in BNP levels&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1539
            "Ancho" => 2332
            "Tamanyo" => 68284
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Correlation between C-reactive protein &#40;CRP&#41; levels and echocardiographic response to cardiac resynchronization therapy&#46; Response was defined as a &#8805;15&#37; decrease in left ventricular end-systolic volume &#40;LVESV&#41;&#46; &#916; CRP&#58; variation in CRP levels&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1511
            "Ancho" => 2333
            "Tamanyo" => 84632
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between B-type natriuretic peptide &#40;BNP&#41; levels and functional response to cardiac resynchronization therapy&#46; Response was defined as a &#8805;10&#37; increase in peak oxygen consumption &#40;VO<span class="elsevierStyleInf">2</span> max&#41;&#46; &#916; BNP&#58; variation in BNP levels&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1515
            "Ancho" => 2307
            "Tamanyo" => 79411
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Correlation between C-reactive protein &#40;CRP&#41; levels and functional response to cardiac resynchronization therapy&#46; Response was defined as a &#8805;10&#37; increase in peak oxygen consumption &#40;VO<span class="elsevierStyleInf">2</span> max&#41;&#46; &#916; CRP&#58; variation in CRP levels&#46;</p>"
        ]
      ]
      4 => 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" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ACEIs&#58; angiotensin-converting enzyme inhibitors&#59; AF&#58; atrial fibrillation&#59; ARBs&#58; angiotensin receptor blockers&#59; BNP&#58; B-type natriuretic peptide&#59; CPET&#58; cardiopulmonary exercise test&#59; Cr&#58; creatinine&#59; CRP&#58; C-reactive protein&#59; Hb&#58; hemoglobin&#59; NR&#58; non-responder&#59; LVEDV&#58; left ventricular end-diastolic volume&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESV&#58; left ventricular end-systolic volume&#59; NYHA&#58; New York Heart Association functional class&#59; R&#58; responder&#59; SD&#58; standard deviation&#59; VE&#47;VCO<span class="elsevierStyleInf">2</span>&#58; minute ventilation-carbon dioxide production slope&#59; VO<span class="elsevierStyleInf">2</span> max&#58; peak oxygen consumption&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LVESV &#8804;15&#37;</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VO<span class="elsevierStyleInf">2</span> max &#8805;10&#37;</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">R &#40;59&#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">NR &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R &#40;68&#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">NR &#40;47&#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" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Demographic</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;5&#177;14&#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">66&#46;5&#177;8&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;5&#177;9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#46;4&#177;10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female &#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">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Clinical</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ischemic etiology &#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&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AF &#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NYHA II&#47;III&#47;IV &#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&#46;4&#47;62&#46;9&#47;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;9&#47;75&#46;0&#47;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&#47;66&#46;7&#47;2&#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">25&#46;9&#47;70&#46;4&#47;3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoker &#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">13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes &#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">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#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">41&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension &#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">75&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia &#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&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesity &#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">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Family history &#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&#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">26&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#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">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Medication</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anticoagulants &#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&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blockers &#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">69&#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">76&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACEIs&#47;ARBs &#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">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics &#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">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#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">79&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CRP &#40;mg&#47;l&#41; &#40;mean &#177; SD&#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&#46;6&#177;24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;1&#177;7&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;55&#177;5&#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">3&#46;0&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BNP &#40;pg&#47;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">530&#46;9&#177;528&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">636&#46;0&#177;657&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">520&#46;7&#177;439&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">404&#46;3&#177;485&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cr &#40;mg&#47;dl&#41; &#40;mean &#177; SD&#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;16&#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;10&#177;0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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;07&#177;0&#46;67&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;15&#177;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hb &#40;g&#47;dl&#41; &#40;mean &#177; SD&#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&#46;1&#177;0&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;8&#177;0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;9&#177;0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;3&#177;0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Electrocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>QRS width &#40;ms&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">172&#46;0&#177;24&#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">165&#46;8&#177;38&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">166&#177;25&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">176&#46;6&#177;25&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Echocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVEF &#40;&#37;&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;8&#177;6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;3 &#177;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;6&#177;7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;7&#177;5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVEDV &#40;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">231&#46;8&#177;69&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202&#46;4&#177;61&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">225&#46;6&#177;68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">218&#46;5&#177;84&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVESV &#40;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">173&#46;8&#177;58&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">143&#46;6&#177;59&#46;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;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165&#46;0&#177;64&#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">163&#46;3&#177;68&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">CPET</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span> max &#40;ml&#47;min&#47;kg&#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&#46;1&#177;6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;0&#177;15&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;1&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;6&#177;5&#46;2&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;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VE&#47;VCO<span class="elsevierStyleInf">2</span> slope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;9&#177;9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;7&#177;37&#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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;3&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;2&#177;10&#46;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;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"><span class="elsevierStyleHsp" style=""></span>Duration &#40;min&#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&#46;63&#177;2&#46;62&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;8&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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;02&#177;1&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;0&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1702748.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of echocardiographic and functional responders and non-responders&#46;</p>"
        ]
      ]
      5 => 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" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BNP&#58; B-type natriuretic peptide&#59; CPET&#58; cardiopulmonary exercise testing&#59; CRP&#58; C-reactive protein&#59; LVEDV&#58; left ventricular end-diastolic volume&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESV&#58; left ventricular end-systolic volume&#59; VE&#47;VCO<span class="elsevierStyleInf">2</span>&#58; minute ventilation-carbon dioxide production slope&#59; VO<span class="elsevierStyleInf">2</span> max&#58; peak oxygen consumption&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">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">Six-month follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CRP &#40;mg&#47;l&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0&#177;15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5&#177;15&#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">p&#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"><span class="elsevierStyleHsp" style=""></span>BNP &#40;pg&#47;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">533&#46;6&#177;553&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">404&#46;9&#177;530&#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">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Electrocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>QRS width &#40;ms&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172&#46;1&#177;28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">169&#46;4&#177;13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Echocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVEF &#40;&#37;&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;4&#177;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;7&#177;11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#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"><span class="elsevierStyleHsp" style=""></span>LVEDV &#40;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&#46;6&#177;69&#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">201&#46;3&#177;81&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#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"><span class="elsevierStyleHsp" style=""></span>LVESV &#40;ml&#41; &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158&#46;1&#177;57&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&#46;4&#177;66&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">CPET</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span> max &#40;ml&#47;min&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#177;4&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#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"><span class="elsevierStyleHsp" style=""></span>VE&#47;VCO<span class="elsevierStyleInf">2</span> slope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;0&#177;11&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;4&#177;7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#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"><span class="elsevierStyleHsp" style=""></span>Duration &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7&#177;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&#177;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1702747.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Laboratory&#44; electrocardiographic&#44; echocardiographic and cardiopulmonary exercise test data at baseline and six-month follow-up&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy reduces the risk of hospitalizations in patients with advanced heart failure&#58; results from the Comparison of Medical Therapy&#44; Pacing and Defibrillation in Heart Failure &#40;COMPANION&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46;S&#46; Anand"
                            1 => "P&#46; Carson"
                            2 => "E&#46; Galle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.793273"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2009"
                        "volumen" => "119"
                        "paginaInicial" => "969"
                        "paginaFinal" => "977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19204305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Linde"
                            1 => "W&#46;T&#46; Abraham"
                            2 => "M&#46;R&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.08.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1834"
                        "paginaFinal" => "1843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19038680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review&#58; cardiac resynchronization in patients with symptomatic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;A&#46; McAlister"
                            1 => "J&#46;A&#46; Ezekowitz"
                            2 => "N&#46; Wiebe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2004"
                        "volumen" => "141"
                        "paginaInicial" => "381"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15353430"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Wells"
                            1 => "R&#46; Parkash"
                            2 => "J&#46;S&#46; Healey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Can Med Assoc J"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "421"
                        "paginaFinal" => "429"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of cardiac resynchronization therapy on reverse remodeling and relation to outcome&#58; multicenter automatic defibrillator implantation trial&#58; cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;D&#46; Solomon"
                            1 => "E&#46; Foster"
                            2 => "M&#46; Bourgoun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.955039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "985"
                        "paginaFinal" => "992"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20733097"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; definition&#44; diagnosis&#44; and management of the cardiac resynchronization therapy nonresponder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Q&#46; Zhang"
                            1 => "Y&#46; Zhou"
                            2 => "C&#46;-M&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HCO.0000000000000140"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Cardiol"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "paginaInicial" => "40"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25469590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drug and device effects on peak oxygen consumption&#44; 6-minute walk distance&#44; and natriuretic peptides as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;S&#46; Wessler"
                            1 => "D&#46;G&#46; Kramer"
                            2 => "J&#46;L&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.111.961573"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "578"
                        "paginaFinal" => "588"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21705485"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of cardiac resynchronization therapy on exercise performance&#44; functional capacity&#44; and quality of life in systolic heart failure with QRS prolongation&#58; COMPANION trial sub-study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; De Marco"
                            1 => "E&#46; Wolfel"
                            2 => "A&#46;M&#46; Feldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2007.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "9"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18226768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy improves minute ventilation&#47;carbon dioxide production slope and skeletal muscle capillary density without reversal of skeletal muscle pathology or inflammation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;I&#46; Larsen"
                            1 => "S&#46; Lindal"
                            2 => "K&#46; Myreng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eus428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "857"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23322010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Agreement is poor among current criteria used to define response to cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;K&#46; Fornwalt"
                            1 => "W&#46;W&#46; Sprague"
                            2 => "P&#46; BeDell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.910778"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "121"
                        "paginaInicial" => "1985"
                        "paginaFinal" => "1991"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20421518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between brain natriuretic peptide&#44; markers of inflammation and the objective and subjective response to cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Brouwers"
                            1 => "H&#46; Versteeg"
                            2 => "M&#46; Meine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbi.2014.03.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain Behav Immun"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "211"
                        "paginaFinal" => "218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24704567"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurohormonal and inflammatory markers as predictors of short-term outcome in patients with heart failure and cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Glick"
                            1 => "Y&#46; Michowitz"
                            2 => "G&#46; Keren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Isr Med Assoc J"
                        "fecha" => "2006"
                        "volumen" => "8"
                        "paginaInicial" => "391"
                        "paginaFinal" => "395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16833167"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of cardiac resynchronization therapy on systemic inflammation and neurohormonal pathways in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Tarquini"
                            1 => "C&#46;T&#46; Guerra"
                            2 => "M&#46;C&#46; Porciani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol J"
                        "fecha" => "2009"
                        "volumen" => "16"
                        "paginaInicial" => "545"
                        "paginaFinal" => "552"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19950091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy &#8211; clinical and echocardiographic characteristics of responders and exceptional responders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Galrinho"
                            1 => "L&#46;M&#46; Branco"
                            2 => "M&#46;M&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "959"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19998807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of high-sensitivity C-reactive protein in heart failure&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Ara&#250;jo"
                            1 => "P&#46; Louren&#231;o"
                            2 => "A&#46; Azevedo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2008.10.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "256"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19327628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High sensitivity C-reactive protein predicts nonresponders and cardiac deaths in severe heart failure patients after CRT implantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Kamioka"
                            1 => "H&#46; Suzuki"
                            2 => "S&#46; Yamada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Heart J"
                        "fecha" => "2012"
                        "volumen" => "53"
                        "paginaInicial" => "306"
                        "paginaFinal" => "312"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23038092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elevated C-reactive protein in acute coronary syndrome presentation is an independent predictor of long-term mortality and heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Kavsak"
                            1 => "A&#46;R&#46; MacRae"
                            2 => "A&#46;M&#46; Newman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinbiochem.2006.10.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Biochem"
                        "fecha" => "2007"
                        "volumen" => "40"
                        "paginaInicial" => "326"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17292342"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "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;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Developed in collaboration with the European Heart Rhythm Association &#40;EHRA&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for quantitation of the left ventricle by two-dimensional echocardiography&#46; American Society of Echocardiography Committee on Standards&#44; Subcommittee on Quantitation of Two-Dimensional Echocardiograms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46;B&#46; Schiller"
                            1 => "P&#46;M&#46; Shah"
                            2 => "M&#46; Crawford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "1989"
                        "volumen" => "2"
                        "paginaInicial" => "358"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2698218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is treatment success in cardiac resynchronization therapy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;W&#46;X&#46; Foley"
                            1 => "F&#46; Leyva"
                            2 => "M&#46;P&#46; Frenneaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eup308"
                      "Revista" => array:7 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2009"
                        "volumen" => "11"
                        "numero" => "Suppl&#46; 5"
                        "paginaInicial" => "v58"
                        "paginaFinal" => "v65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19861392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Which echocardiographic definition should be used to define response to cardiac resynchronization therapy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Ant&#243;nio"
                            1 => "R&#46; Teixeira"
                            2 => "C&#46; Louren&#231;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "943"
                        "paginaFinal" => "958"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19998806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;G&#46; Balci"
                            1 => "M&#46;M&#46; Balci"
                            2 => "F&#46; Sen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5603/KP.a2015.0142"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kardiol Pol"
                        "fecha" => "2016"
                        "volumen" => "74"
                        "paginaInicial" => "119"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26202536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antiinflammatory effects of cardiac resynchronization therapy in patients with chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;N&#46; Theodorakis"
                            1 => "P&#46; Flevari"
                            2 => "C&#46; Kroupis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8159.2006.00331.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "255"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16606392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical&#44; echocardiographic&#44; and neurohormonal response to cardiac resynchronization therapy&#58; are they interchangeable&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;E&#46; Hoogslag"
                            1 => "U&#46; H&#246;ke"
                            2 => "J&#46; Thijssen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pace.12214"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2013"
                        "volumen" => "36"
                        "paginaInicial" => "1391"
                        "paginaFinal" => "1401"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23826659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;M&#46; Yu"
                            1 => "G&#46;B&#46; Bleeker"
                            2 => "Fung JW-H"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.538272"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "paginaInicial" => "1580"
                        "paginaFinal" => "1586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16144994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reverse cardiac remodeling&#58; a marker of better prognosis in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; de A&#46;R&#46; Reis"
                            1 => "J&#46;N&#46; Cardoso"
                            2 => "C&#46;M&#46; dos R&#46; Cardoso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5935/abc.20150025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2015"
                        "volumen" => "104"
                        "paginaInicial" => "502"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26131706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of clinical and echocardiographic response to cardiac resynchronization therapy on long-term survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Bertini"
                            1 => "U&#46; H&#246;ke"
                            2 => "R&#46;J&#46; van Bommel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ehjci/jes290"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Cardiovasc Imaging"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "774"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23221312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of cardiac resynchronization therapy response"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Cattadori"
                            1 => "F&#46; Giraldi"
                            2 => "M&#46; Berti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2008.04.052"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "paginaInicial" => "240"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18672300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-inflammatory effect of cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;T&#46; Lappeg&#229;rd"
                            1 => "H&#46; Bj&#248;rnstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8159.2006.00430.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "753"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16884512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of mortality in chronic heart failure from peak oxygen consumption adjusted for either body weight or lean tissue"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Cicoira"
                            1 => "C&#46;H&#46; Davos"
                            2 => "D&#46;P&#46; Francis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "421"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15470653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Listing criteria for heart transplantation&#58; International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates &#8211; 2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Mehra"
                            1 => "J&#46; Kobashigawa"
                            2 => "R&#46; Starling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2006.06.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "1024"
                        "paginaFinal" => "1042"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16962464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic impact of peakVO<span class="elsevierStyleInf">2</span>-changes in stable CHF on chronic beta-blocker treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Frankenstein"
                            1 => "M&#46; Nelles"
                            2 => "M&#46; Hallerbach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2006.11.038"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2007"
                        "volumen" => "122"
                        "paginaInicial" => "125"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17222927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory activation following interruption of long-term cardiac resynchronization therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Rubaj"
                            1 => "P&#46; Ruci&#324;ski"
                            2 => "K&#46; Oleszczak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00380-012-0285-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Vessels"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "583"
                        "paginaFinal" => "588"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23242167"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300588/v1_201803200458/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000002/v1_201803200458/S2174204918300588/v1_201803200458/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300588?idApp=UINPBA00004E"
]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2018.03.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	6	11
2024 October	29	20	49
2024 September	29	22	51
2024 August	34	25	59
2024 July	47	32	79
2024 June	22	19	41
2024 May	21	20	41
2024 April	24	24	48
2024 March	35	21	56
2024 February	37	17	54
2024 January	16	23	39
2023 December	22	25	47
2023 November	21	20	41
2023 October	21	30	51
2023 September	17	16	33
2023 August	26	20	46
2023 July	28	5	33
2023 June	17	15	32
2023 May	43	21	64
2023 April	30	6	36
2023 March	66	24	90
2023 February	45	16	61
2023 January	17	16	33
2022 December	78	25	103
2022 November	75	26	101
2022 October	67	28	95
2022 September	61	37	98
2022 August	74	24	98
2022 July	61	47	108
2022 June	62	28	90
2022 May	53	33	86
2022 April	51	30	81
2022 March	33	33	66
2022 February	24	35	59
2022 January	28	32	60
2021 December	21	35	56
2021 November	30	29	59
2021 October	31	46	77
2021 September	24	30	54
2021 August	38	33	71
2021 July	27	20	47
2021 June	23	37	60
2021 May	39	61	100
2021 April	66	77	143
2021 March	43	28	71
2021 February	47	18	65
2021 January	32	24	56
2020 December	41	13	54
2020 November	28	15	43
2020 October	17	13	30
2020 September	46	7	53
2020 August	21	7	28
2020 July	48	14	62
2020 June	37	9	46
2020 May	34	9	43
2020 April	32	16	48
2020 March	43	10	53
2020 February	45	22	67
2020 January	37	4	41
2019 December	46	7	53
2019 November	32	9	41
2019 October	41	5	46
2019 September	22	10	32
2019 August	29	4	33
2019 July	43	7	50
2019 June	23	17	40
2019 May	35	15	50
2019 April	25	20	45
2019 March	28	12	40
2019 February	56	9	65
2019 January	31	9	40
2018 December	47	11	58
2018 November	61	8	69
2018 October	69	20	89
2018 September	29	10	39
2018 August	30	6	36
2018 July	19	3	22
2018 June	29	4	33
2018 May	27	6	33
2018 April	75	13	88
2018 March	48	11	59

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter