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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac remodeling is defined as genome expression resulting in molecular&#44; cellular and interstitial changes and manifested clinically as changes in size&#44; shape and function of the heart&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> The progression of heart failure &#40;HF&#41; is associated with left ventricular &#40;LV&#41; remodeling&#44; which manifests as gradual increases in LV end-diastolic and end-systolic volumes&#44; wall thinning&#44; and a change in chamber geometry to a more spherical&#44; less elongated shape&#44; with a progressive decrease in ejection fraction &#40;EF&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">When ventricular remodeling is advanced&#44; it begins to be self-sustaining and capable of driving disease progression&#44; regardless of the patient&#39;s neurohormonal status&#46; This may explain why medical therapies lose their effectiveness in end-stage HF&#44; and why some device-based therapies &#40;cardiac resynchronization and mechanical ventricular assistance&#41;&#44; which can affect LV remodeling&#44; are beneficial&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The overall importance of ventricular remodeling as a pathogenic mechanism and prognostic determinant is not clear&#46; Some drug therapies and cardiac devices that increase the survival of patients with HF can slow&#44; and in some cases even reverse&#44; certain parameters of remodeling&#46; Controversially&#44; as in the case of etanercept<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> and in cardiac resynchronization&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#44;4</span></a> reverse remodeling has not translated into increased survival&#46; Additionally&#44; the molecular mechanisms of reverse remodeling have not been fully elucidated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Left ventricular reverse remodeling &#40;LVRR&#41; is characterized by a decrease in LV dimensions&#44; normalization of LV shape and improvement of systolic function&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A significant prevalence of recovery of LV function in patients with dilated cardiomyopathy &#40;DCM&#41; has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> However&#44; such studies included patients with new-onset DCM like acute myocarditis&#44; and other reversible causes of DCM&#44; such as peripartum and alcohol-related DCM&#46; The mechanisms underlying LVRR in such situations appear to be different from those involved in chronic idiopathic DCM&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this prospective study was to assess recovery of LV function and reversal of ventricular remodeling in patients with chronic idiopathic DCM&#44; after optimized medical therapy&#46; We set out to assess its prevalence&#44; to identify its predictors and to determine whether it was associated with better prognosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study included consecutive adult patients with idiopathic DCM &#40;left ventricular diastolic diameter &#91;LVDD&#93; &#62;33 mm&#47;m<span class="elsevierStyleSup">2</span> in men&#44; &#62;32 mm&#47;m<span class="elsevierStyleSup">2</span> in women&#41; between 2000 and June 2012 followed in an HF clinic&#44; diagnosed less than 24 months previously and with two initial values of left ventricular ejection fraction &#40;LVEF&#41; of &#60;0&#46;40 more than one year apart&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We excluded DCM patients with secondary etiologies&#44; including a history of myocardial infarction or angina&#44; those with ischemia or significant coronary disease on coronary angiography&#44; a history of moderate or severe hypertension&#44; at least moderate primary mitral or aortic valvular disease&#44; heavy alcohol use &#40;&#62;100 g&#47;day&#41;&#44; chemotherapy-induced and peripartum cardiomyopathy&#44; acute HF with biopsy positive for acute myocarditis or positive serology for acute bacterial or viral infection&#46; We included patients with idiopathic DCM&#44; diagnosed after respiratory infections but with LV dysfunction that persisted for over a year &#40;in order to exclude myocarditis&#41;&#46; We also excluded patients with uncontrolled atrial and ventricular arrhythmias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At baseline&#44; patients underwent clinical assessment&#44; electrocardiogram &#40;ECG&#41;&#44; 24-hour ECG&#44; transthoracic echocardiogram&#44; blood laboratory measurements&#44; cardiopulmonary exercise testing &#40;CPET&#41; and cardiac magnetic resonance &#40;CMR&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients were managed according to current clinical practice guidelines and clinicians aimed to reach the recommended target doses for all therapies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During follow-up&#44; periodic clinical assessment&#44; laboratory measurements and echocardiogram were performed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This study was in accordance with the recommendations set by the Declaration of Helsinki and with local legal requirements&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Definition of left ventricular reverse remodeling</span><p id="par0065" class="elsevierStylePara elsevierViewall">LVRR was defined as an absolute increase on two consecutive echocardiograms more than six months apart of 10 units of LVEF&#44; together with a decrease in left ventricular diastolic diameter &#40;LVDD&#41;&#44; without worsening of mitral regurgitation&#44; in the absence of cardiac resynchronization therapy &#40;CRT&#41; or mechanical ventricular assistance&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Transthoracic echocardiography protocol</span><p id="par0070" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography was performed at baseline and during follow-up using two commercially available systems&#58; General Electric Vivid 3&#46;0 and Vivid 7&#46;0 with a 2&#46;5-MHz transducer&#46; The following parameters were measured according to the standards defined by the American Society of Echocardiography and the European Association of Echocardiography<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#58; LVDD and end-systolic diameter&#59; LV EF &#40;&#37;&#41; calculated by Simpson&#39;s biplane method&#59; degree of mitral regurgitation by Doppler and color Doppler&#44; on a scale from 0 to 4&#59; left atrial diameter&#59; LV posterior wall thickness and interventricular septal thickness&#59; right ventricular systolic dysfunction &#40;defined as tricuspid annular systolic excursion &#91;TAPSE&#93; &#60;16 mm&#41;&#59; and pulmonary artery systolic pressure &#40;PASP&#41; calculated by tricuspid velocities&#46; Data on diastolic function were incomplete&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients who received CRT were considered have no LVRR&#44; so EF and LVDD before CRT were included in the analysis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">All data were digitally stored&#44; and off-line data analysis was performed by two echocardiography specialists&#44; blinded to the study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Cardiopulmonary stress testing</span><p id="par0085" class="elsevierStylePara elsevierViewall">Patients underwent maximal symptom-limited CPET &#40;Jaeger Oxycon Mobile 4&#46;6&#41;&#46; Blood pressure was measured manually and a modified Bruce protocol was used&#46; All tests were interrupted due to symptoms&#46; Expired ventilatory flow &#40;VE&#41;&#44; oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41;&#44; carbon dioxide output &#40;VCO<span class="elsevierStyleInf">2</span>&#41; and other cardiopulmonary variables were acquired breath-by-breath by pneumotachograph with bidirectional differential pressure&#46; Peak oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span> peak&#41; was calculated as the mean values during the last 30 s of effort&#46; The anaerobic threshold &#40;AT&#41; was calculated automatically by the V-slope method&#46; We also determined circulatory power &#40;VO<span class="elsevierStyleInf">2</span> peak&#215;peak systolic blood pressure&#41;&#44; VE&#47;VCO<span class="elsevierStyleInf">2</span> slope&#44; ventilatory equivalent for oxygen &#40;VE&#47;VO<span class="elsevierStyleInf">2</span>&#41; and VE&#47;CO<span class="elsevierStyleInf">2</span> slope normalized for peak VO<span class="elsevierStyleInf">2</span>&#46; Because of the limitations of the system&#44; instead of calculating the oxygen uptake efficiency slope&#44; we calculated peak oxygen uptake efficiency &#40;POUE&#41; &#40;peak VO<span class="elsevierStyleInf">2</span>&#47;log 10 peak VE&#41; at AT&#44; which is more easily obtained and has similar prognostic value&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The Heart Failure Survival Score &#40;HFSS&#41; was calculated by the equation&#58; &#40;0&#46;0216&#215;heart rate&#41;&#43;&#40;&#8722;0&#46;0255&#215;mean blood pressure&#41;&#43;&#40;&#8722;0&#46;0464&#215;EF&#41;&#43;&#40;&#8722;0&#46;0470&#215;Na&#43; concentration&#41;&#43;&#40;&#8722;0&#46;0546&#215;peak VO<span class="elsevierStyleInf">2</span>&#41;&#43;&#40;0&#46;6083&#215;QRS&#62;120 ms 1&#44; no 0&#41;&#43;&#40;0&#46;6931&#215;ischemic etiology 1&#44; no 0&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Cardiac magnetic resonance</span><p id="par0095" class="elsevierStylePara elsevierViewall">The CMR studies were performed on a 3 T clinical scanner &#40;Siemens<span class="elsevierStyleSup">&#174;</span> Magnetom Trio&#41;&#46; Electrocardiogram-gated cine steady-state free precession imaging was performed in short-axis and orthogonal LV long-axis views&#46; A breath-hold&#44; T2-weighted dark blood sequence was acquired&#46; Late gadolinium enhancement &#40;LGE&#41; images were acquired 10&#8211;15 min after gadolinium administration using a phase-sensitive inversion-recovery sequence&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The extent of LGE was quantified by the number of segments affected&#46; The presence and distribution of LGE were independently determined by one radiologist and one cardiologist&#44; blinded to the study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall">All values are reported as mean &#177; SD&#44; median &#177; interquartile range or percentages according to data characteristics&#46; Differences between subjects in each arm were assessed using the chi-square test for categorical variables and the Student&#39;s t test or the Mann-Whitney test for continuous variables&#44; as appropriate&#46; A two-tailed p&#60;0&#46;05 was considered to indicate statistical significance&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">To assess predictors of LVRR from baseline characteristics and from therapy&#44; univariate analysis included all relevant clinical or laboratory parameters&#46; Variables with p&#60;0&#46;05 from the univariate analysis were entered in multivariate Cox regression analysis&#44; but variables with low quantities of data &#40;those from 24-hour ECG&#44; CPET and CMR&#41; were excluded&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Population characteristics</span><p id="par0115" class="elsevierStylePara elsevierViewall">A total of 113 patients were included&#44; followed for 7&#46;1&#177;5&#46;6 years&#44; mean age 50&#177;14 years&#59; 74 were male &#40;66&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">At baseline&#44; mean EF was 27&#177;8&#37;&#44; LVDD was 67&#177;9 mm&#44; LVDD index was 37&#46;1&#177;6&#46;3 mm&#47;m<span class="elsevierStyleSup">2</span> and grade &#62;II mitral regurgitation was present in 34&#37; of patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">On ECG&#44; 44&#37; had left bundle branch block &#40;LBBB&#41;&#44; 46&#37; had LV conduction disturbances and 14&#37; had atrial fibrillation&#46; The majority of patients were in NYHA class II &#40;69&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the patients&#8217; baseline clinical characteristics&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">At the end of follow-up&#44; 90&#37; were treated with angiotensin-converting enzyme inhibitors &#40;ACEI&#41;&#47;angiotensin receptor blockers &#40;ARB&#41;&#44; 64&#37; with beta-blockers&#44; 30&#37; with aldosterone antagonists and 33&#37; with digoxin&#46; Optimal recommended doses of ACEI&#47;ARB were reached in 52&#46;2&#37; &#40;20&#8211;30 mg lisinopril&#44; 5&#8211;10 mg perindopril&#44; 16&#8211;32 mg candesartan&#41; and optimal doses of beta-blockers were reached in 47&#46;8&#37; &#40;25&#8211;50 mg bid carvedilol&#44; 5&#8211;10 mg bisoprolol&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows therapy at baseline and at the end of follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Urgent heart transplantation or death occurred in 16&#37; of patients &#40;nine deaths&#44; nine transplantations&#41;&#44; 38&#37; were hospitalized for worsening HF and 30&#37; had cardiac devices implanted&#58; implantable cardioverter-defibrillator &#40;ICD&#41; in 19&#37;&#44; CRT plus ICD in 8&#37;&#44; and CRT pacing in 3&#37;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Prevalence and prognostic value of left ventricular reverse remodeling</span><p id="par0140" class="elsevierStylePara elsevierViewall">Initial EF in patients who recovered LV function was 28&#177;9&#37;&#44; not significantly different from the 27&#177;9&#37; in those who did not recover&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">LVRR occurred in 39 patients &#40;34&#46;5&#37;&#41; within 22&#46;6 months &#40;median&#41;&#46; Final EF was 47&#46;5&#177;10&#46;1&#37; &#40;&#916; EF 19&#46;4&#177;9&#46;0&#37;&#41;&#44; LVDD was 55&#46;7&#177;6&#46;7 mm &#40;&#916; LVDD &#8722;9&#46;6&#177;&#8722;7&#46;4 mm&#41;&#44; LVDD index was 30&#46;2&#177;3&#46;9 mm&#47;m<span class="elsevierStyleSup">2</span> and only 3&#46;5&#37; had grade &#62;II MR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Patients with LVRR had better NYHA functional capacity&#58; class I &#40;67&#37; vs&#46; 25&#37;&#44; p&#60;0&#46;01&#41;&#44; class II &#40;43&#37; vs&#46; 31&#37;&#44; p&#60;0&#46;01&#41; and had lower BNP &#40;median 27&#46;4 vs&#46; 160&#46;0 pg&#47;ml&#44; p&#60;0&#46;01&#41;&#44; compared with those without LVRR&#46; LVRR was associated with lower rates of HF hospitalization &#40;23&#46;1&#37; vs&#46; 44&#46;6&#37;&#44; p&#61;0&#46;02&#41;&#44; cardiac death and urgent transplantation &#40;0&#46;0&#37; vs&#46; 24&#46;3&#37;&#44; p&#60;0&#46;01&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Factors predicting left ventricular reverse remodeling</span><p id="par0155" class="elsevierStylePara elsevierViewall">Because of technical reasons and pre-existing contraindications&#44; only 89 patients underwent 24-hour ECG&#44; only 55 patients underwent CPET and only 38 underwent CMR at baseline&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Variables at baseline that predicted LVRR were &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#58; mild hypertension &#40;54&#37; vs&#46; 32&#37;&#44; p&#60;0&#46;05&#41;&#44; atrial fibrillation &#40;26&#37; vs&#46; 8&#37;&#44; p&#60;0&#46;05&#41;&#44; ventricular hypertrophy on ECG &#40;36&#37; vs&#46; 14&#37;&#44; p&#60;0&#46;05&#41;&#44; absence of LBBB &#40;31&#37; vs&#46; 51&#37;&#44; p&#60;0&#46;04&#41;&#44; shorter QRS interval &#40;117 ms vs&#46; 131 ms&#44; p&#60;0&#46;05&#41;&#44; higher hematocrit &#40;43&#46;2 vs&#46; 40&#46;8&#37;&#44; p&#60;0&#46;05&#41;&#44; lower LVDD index &#40;35&#46;4 vs&#46; 38&#46;0 mm&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#60;0&#46;05&#41; and less non-sustained ventricular tachycardia on 24-hour ECG &#40;12&#46;5&#37; vs&#46; 33&#46;9&#37;&#44; p&#61;0&#46;03&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Predictor variables from CPET were higher POUE &#40;0&#46;879 vs&#46; 0&#46;734&#44; p&#60;0&#46;05&#41; and lower dVE&#47;VCO<span class="elsevierStyleInf">2</span>&#47;VO<span class="elsevierStyleInf">2</span> &#40;2&#46;5 vs&#46; 4&#46;0&#44; p&#60;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Mean calculated HFSS was 8&#46;97&#177;0&#46;85&#44; with 98&#46;2&#37; of patients at low risk and only 1&#46;8&#37; at medium risk&#44; and did not differ in patients who did not recover EF&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Non-transmural LGE &#40;showing midwall fibrosis&#41; on CMR was present in 55&#46;3&#37; of patients&#59; in 26&#46;3&#37; it was limited to one LV segment and in 28&#46;9&#37; it was observed in more than one segment&#46; LGE or other CMR parameters&#44; such as right ventricular EF&#44; were not predictors of LVRR &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">During follow-up&#44; patients in the LVRR group were more often treated with ACEI&#47;ARB &#40;100&#37; vs&#46; 92&#37;&#44; p&#60;0&#46;05&#41; and with maximal doses &#40;80&#37; vs&#46; 39&#37;&#44; p&#60;0&#46;01&#41;&#46; There were no differences in the use of beta-blockers&#44; but those who had LVRR more often reached maximal doses &#40;67&#37; vs&#46; 34&#37;&#44; p&#60;0&#46;01&#41; and were less often medicated with aldosterone antagonists &#40;33&#37; vs&#46; 61&#37;&#44; p&#60;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Multivariate regression analysis showed that only treatment with recommended doses of ACEI&#47;ARB &#40;OR&#58; 0&#46;32&#44; 95&#37; CI 0&#46;11&#8211;0&#46;92&#41; was independently associated with LVRR&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0190" class="elsevierStylePara elsevierViewall">In the present study&#44; we describe the frequency of improvement in LV systolic function in patients with chronic idiopathic DCM in an unselected population&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">LVRR has been described in secondary forms of DCM&#44; such as peripartum cardiomyopathy&#44; alcohol abuse&#44; myocarditis and ischemic heart disease&#44; but the mechanisms underlying such conditions are different from those in idiopathic DCM&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">A significant prevalence of recovery of LV function has also been described in recent-onset DCM&#46; Those patients have a higher potential for LVRR&#44; due to resolution of the underlying disease&#44; as in myocarditis&#44; or to favorable effects of therapy&#46; Kubanek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> reported a prevalence of 45&#37; of LVRR at 12 months in 44 patients with recent-onset DCM&#44; including some with active and resolving myocarditis&#46; We only included patients with idiopathic DCM diagnosed less than 24 months previously&#44; but with two initial values of EF of &#60;0&#46;40 more than one year apart&#44; in order to exclude resolving myocarditis&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In our population&#44; LVRR occurred in approximately one third of patients within 22 months of diagnosis&#46; It was associated with improvement in NYHA functional class&#44; with decrease in BNP compared with those who did not recover&#44; and with excellent prognosis&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Recovery in EF and reverse remodeling was associated with maximal treatment with ACEI&#47;ARB and beta-blockers&#46; Patients with LVRR were less often medicated with aldosterone antagonists&#44; probably because they achieved better NYHA functional class&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A favorable response to drug therapy with ACEI&#44; beta-blockers and aldosterone antagonists was reported&#44; with almost complete reversal of LV dysfunction&#46; An increase in EF of more than 15 units has been described&#44; associated with increases in functional capacity and cardiac index and a decrease in pulmonary capillary pressure&#44; associated with a better prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">11&#8211;14</span></a> Treatment of HF can influence hemodynamics by decreasing LV afterload and preload&#46; The experimental literature suggests that alterations in the biology and contractility of the failing cardiac myocyte may be reversible after beta blockade&#46; Recent studies in patients treated with beta-blockers who had an increase in EF also showed favorable changes in myocardial gene expression&#58; an increase in sarcoplasmic reticulum calcium ATPase mRNA and alpha-myosin heavy chain mRNA and a decrease in beta-myosin heavy chain mRNA&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">In our study&#44; patients with LVRR more often had hypertension and appeared to be at an earlier stage of the disease&#44; with lower LVDD&#44; shorter QRS interval&#44; less LBBB and more favorable ventilatory efficiency&#46; Patients with hypertension and LV dysfunction respond to appropriate afterload-reducing therapy with improvements in LV function&#44; and probably more frequently and more rapidly reach maximum drug titration with beta-blockers and ACEI&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Although only 14&#37; of patients had AF at first consultation&#44; the higher percentage of AF among patients who recovered EF was somewhat surprising&#46; One possible explanation is that AF might have developed simultaneously with heart failure&#44; causing functional changes &#40;irregular and rapid rhythm&#44; loss of atrioventricular synchrony&#44; and loss of atrial transport&#41;&#44; which would then show maximum benefit from medical therapy&#44; with reversal of ventricular dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">The predictors of RRVE in CPET were higher POUE and lower dVE&#47;VCO<span class="elsevierStyleInf">2</span>&#47;VO<span class="elsevierStyleInf">2</span>&#46; Decreased oxygen efficiency slope and lower ventilatory efficiency&#44; determined by the VE&#47;CO<span class="elsevierStyleInf">2</span> slope&#44; additionally normalized for peak VO<span class="elsevierStyleInf">2</span>&#44; are sensitive and early prognostic factors of heart failure&#44; reflecting more advanced disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Our results are consistent with other studies that set out to define the clinical variables associated with improvement in LVEF&#46; Cicoira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> evaluated 98 patients with idiopathic DCM&#44; and found that those who recovered LV systolic function had shorter duration of symptoms&#44; worse NYHA class and a history of hypertension&#46; In a large study&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> LVRR was found in 89 of 242 idiopathic DCM patients &#40;37&#37;&#41; and baseline predictors were higher systolic blood pressure and absence of LBBB&#46; Binkley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> showed that patients who recovered LV function were younger&#44; had higher systolic blood pressure&#44; lower serum creatinine&#44; shorter QRS interval&#44; lower prevalence of diabetes and higher prevalence of hypertension&#44; were more frequently female and had a lower prevalence of ischemic cardiomyopathy&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">It has been postulated that non-ischemic etiology has a higher probability of reverse remodeling&#46; This appears to be related to a higher degree of adrenergic activation for an equivalent degree of myocardial dysfunction and to a greater extent of viable myocardium in patients with idiopathic DCM&#46; A marked reduction in sympathetic activity appears to reduce mortality&#46; The extent of heart rate reduction&#44; rather than its baseline level&#44; appears to be associated with a greater increase in LV function&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Contractile reserve has been suggested as a key predictor of LVRR&#44; according to studies with dobutamine echocardiography<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> and positron emission tomography&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> CMR with gadolinium administration indirectly demonstrates contractile reserve in patients with idiopathic DCM&#44; through the presence of myocardial fibrosis&#46; Some studies have assessed the prognostic value of CMR in non-ischemic DCM&#46; In the study by Assomull et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> midwall fibrosis was present in 35&#37; of 101 patients and was associated with a higher rate of the primary combined endpoint of all-cause death and cardiovascular events&#46; In one study of recent-onset DCM&#44; the lower extent of LGE and the higher edema ratio at CMR were the most important baseline predictors of LVRR&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> In our study&#44; the presence or extent of LGE was not a predictor of LVRR&#44; possibly due to the small study population&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">QRS duration is one of the most sensitive independent predictors of survival in patients with DCM&#46; In our population&#44; mean QRS duration of patients who did not recover LV function was 130 ms&#46; This finding is consistent with recommendations for biventricular pacing&#46; Patients with LVRR also less often had non-sustained ventricular tachycardia on 24-hour ECG&#44; probably also reflecting some positive electrical remodeling&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">To summarize&#44; these variables probably discriminate patients in whom EF can recover with medical therapy only from those who may require resynchronization devices or more aggressive strategies&#44; including heart transplantation&#46; Patients whose LV function recovers no longer have indication for ICD or CRT therapy&#44; thus complicating the timing of implantation of these devices&#46; Although current guidelines suggest that an ICD is indicated only in patients already receiving maximal medical therapy&#44; it is not clear how safe it is to wait for optimization of therapy before ICD implantation&#46; We can postulate that in patients with LBBB&#44; low systolic blood pressure and larger LV diameters&#44; it may not be safe to wait for ICD&#47;CRT implantation&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study limitations</span><p id="par0260" class="elsevierStylePara elsevierViewall">In this study we did not perform the expected number of CMR and CPET exams&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Another study is ongoing in our HF clinic&#44; in a cohort of idiopathic DCM patients&#44; all in sinus rhythm&#44; assessing emerging laboratory predictors of LVRR and obtaining detailed echocardiographic data&#44; with volumetric measures and myocardial deformation changes&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0270" class="elsevierStylePara elsevierViewall">LVRR occurred in approximately one third of patients with idiopathic DCM&#44; and these patients appeared to be at an early stage of the disease&#44; had higher blood pressure and had maximal therapy titration&#46; In these cases there is no longer indication for ICD or CRT implantation&#44; thus complicating the timing of implantation of these devices&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical disclosures</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of human and animal subjects</span><p id="par0275" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Confidentiality of data</span><p id="par0280" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0285" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Definition of left ventricular reverse remodeling"
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              "titulo" => "Transthoracic echocardiography protocol"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Cardiopulmonary stress testing"
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              "titulo" => "Cardiac magnetic resonance"
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              "titulo" => "Population characteristics"
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              "identificador" => "sec0050"
              "titulo" => "Prevalence and prognostic value of left ventricular reverse remodeling"
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              "identificador" => "sec0055"
              "titulo" => "Factors predicting left ventricular reverse remodeling"
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              "titulo" => "Protection of human and animal subjects"
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              "titulo" => "Confidentiality of data"
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    "fechaRecibido" => "2015-07-08"
    "fechaAceptado" => "2015-11-21"
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          "clase" => "keyword"
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            0 => "Dilated cardiomyopathy"
            1 => "Reverse remodeling"
            2 => "Prognosis"
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          "palabras" => array:3 [
            0 => "Miocardiopatia dilatada"
            1 => "Remodelagem reversa"
            2 => "Progn&#243;stico"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac remodeling is manifested as changes in size&#44; shape and function of the heart&#46; We studied the prevalence&#44; prognosis and predictors of left ventricular reverse remodeling &#40;LVRR&#41; in idiopathic dilated cardiomyopathy &#40;IDCM&#41; after optimized medical therapy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 113 IDCM patients were followed for 7&#46;1&#177;5&#46;6 years&#46; LVRR was defined as an increase of 10 units in ejection fraction &#40;EF&#41; and decrease in left ventricular diastolic diameter &#40;LVDD&#41;&#44; in the absence of resynchronization therapy&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Baseline EF was 27&#177;8&#37; and LVDD index was 37&#46;1&#177;6&#46;3 mm&#47;m<span class="elsevierStyleSup">2</span>&#46; LVRR occurred in 34&#46;5&#37; within 22&#46;6 months&#46; Final EF was 47&#46;5&#177;10&#46;1&#37;&#44; LVDD index was 30&#46;2&#177;3&#46;9 mm&#47;m<span class="elsevierStyleSup">2</span>&#46; LVRR was associated with better NYHA class &#40;I&#8211;II&#41; and lower BNP &#40;p&#60;0&#46;01&#41; and all patients were alive&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Univariate predictive factors of LVRR &#40;p&#60;0&#46;05&#41; were mild hypertension&#44; atrial fibrillation&#44; ventricular hypertrophy on ECG&#44; absence of left bundle branch block&#44; shorter QRS duration&#44; higher hematocrit&#44; lower LVDD index&#44; higher peak oxygen uptake efficiency &#40;VO<span class="elsevierStyleInf">2</span>&#47;log 10&#91;VE&#93;&#41; and lower dVE&#47;VCO<span class="elsevierStyleInf">2</span>&#47;VO<span class="elsevierStyleInf">2</span>&#44; treatment with angiotensin-converting enzyme inhibitors &#40;ACEI&#41;&#47;angiotensin receptor blockers &#40;ARB&#41; and use of maximal doses of ACEI&#47;ARB and beta-blockers&#46; Multivariate regression analysis showed that higher doses of ACEI&#47;ARB &#40;OR&#58; 0&#46;32&#44; 95&#37; CI 0&#46;11&#8211;0&#46;92&#41; were independently associated with LVRR&#46; Non-transmural late enhancement on cardiac MRI was not a predictor of LVRR&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">LVRR occurred in one third of IDCM patients&#44; especially in those with mild hypertension and with less advanced disease&#44; who may have benefited from maximal drug titration&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A remodelagem ventricular &#233; caracterizada por altera&#231;&#245;es no tamanho&#44; forma e fun&#231;&#227;o do cora&#231;&#227;o&#46; Estud&#225;mos a preval&#234;ncia&#44; o progn&#243;stico e os fatores preditores de revers&#227;o da remodelagem do ventr&#237;culo esquerdo &#40;RRVE&#41; na miocardiopatia dilatada idiop&#225;tica &#40;MCDI&#41;&#44; ap&#243;s a terap&#234;utica farmacol&#243;gica otimizada&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cento e treze doentes foram seguidos durante 7&#44;1&#177;5&#44;6 anos&#46; A RRVE foi definida como um aumento de dezunidades da fra&#231;&#227;o de eje&#231;&#227;o &#40;FE&#41; e diminui&#231;&#227;o do di&#226;metro diast&#243;lico do VE &#40;VED&#41;&#44; na aus&#234;ncia de terap&#234;utica de ressincroniza&#231;&#227;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A FE basal foi de 27&#177;8&#37; e o VED de 37&#44;1 &#177; 6&#44;3 mm&#47;m<span class="elsevierStyleSup">2</span>&#46; A RRVE ocorreu em 34&#44;5&#37; dentro de 22&#44;6 meses&#46; A FE final foi de 47&#44;5 &#177; 10&#44;1&#37;&#44; o VED <span class="elsevierStyleItalic">index</span> foi de 30&#44;2&#177;3&#44;9 mm&#47;m<span class="elsevierStyleSup">2</span>&#46; A RRVE associou-se a melhor classe NYHA &#40;I-II&#41;&#44; menor BNP e a mortalidade nula&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Os preditores de RRVE foram hipertens&#227;o arterial &#40;ligeira&#41;&#44; fibrilha&#231;&#227;o auricular&#44; hipertrofia ventricular esquerda &#40;no ECG&#41;&#44; aus&#234;ncia de bloqueio de ramo esquerdo&#44; menor dura&#231;&#227;o do QRS&#44; maior hemat&#243;crito&#44; menor VED <span class="elsevierStyleItalic">index</span>&#44; melhor efici&#234;ncia de oxig&#233;nio no pico do exerc&#237;cio &#40;VO2&#47;LG10&#91;VE&#93;&#41;&#44; um menor DVE&#47;VCO2&#47;VO2&#44; uso de IECA&#47;ARA-II e uso de doses m&#225;ximas de IECA&#47;ARA-II e bloqueadores-&#946;&#46; Na an&#225;lise multivariada o uso de doses m&#225;ximas de IECA&#47;ARA-II &#40;OR&#58; 0&#44;32&#44; 95&#37; CI 0&#44;11-0&#44;92&#41; foi um preditor independente&#46; A presen&#231;a ou extens&#227;o do realce tardio na RMN card&#237;aca n&#227;o foi preditora de RRVE&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A RRVE ocorreu num ter&#231;o dos pacientes MCDI&#44; naqueles com hipertens&#227;o ligeira e com doen&#231;a menos avan&#231;ada&#44; que poder&#227;o ter beneficiado da m&#225;xima titula&#231;&#227;o dos f&#225;rmacos&#46;</p></span>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Medical therapy at baseline and at the end of follow-up&#46; AA&#58; aldosterone antagonists&#59; ACEI&#58; angiotensin-converting enzyme inhibitors&#59; ARB&#58; angiotensin receptor blockers&#59; BB&#58; beta-blockers&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BSA&#58; body surface area&#59; LBBB&#58; left bundle branch block&#59; LV&#58; left ventricular&#59; LVDD&#58; left ventricular end-diastolic diameter&#59; LVSD&#58; left ventricular end-systolic diameter&#59; NYHA&#58; New York Heart Association&#59; PASP&#58; pulmonary artery systolic pressure&#59; RV&#58; right ventricular&#59; TAPSE&#58; tricuspid annular systolic excursion&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chronic pulmonary disease &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Heart rate &#40;bpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NYHA class II &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NYHA class III &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NYHA class IV &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Atrial fibrillation &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LBBB &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">QRS duration &#40;ms&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&#46;6&#177;31&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LV hypertrophy &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;2&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="2" 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="2" 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>RV dilation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5&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>RV dysfunction &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&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>TAPSE &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;4&#177;4&#46;5&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>Grade &#62;II&#47;IV tricuspid regurgitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;4&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>PASP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;6&#177;16&#46;0&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>LVDD &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;0&#177;8&#46;7&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>LVSD &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;0&#177;8&#46;1&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>LVDD&#47;BSA &#40;mm&#47;mm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;1&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ejection fraction &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;2&#177;8&#46;2&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>LV mass&#47;BSA &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&#46;1&#177;30&#46;4&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>Grade &#62;II&#47;IV mitral regurgitation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;6&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>Left atrial diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;7&#177;6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BNP&#58; natriuretic brain peptide&#59; CI&#58; confidence interval&#59; HR&#58; heart rate&#59; LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVVR&#58; left ventricular reverse remodeling&#59; OR&#58; odds ratio&#59; SDNN&#58; standard deviation of NN interval&#59; VT&#58; ventricular tachycardia&#46; Other abbreviations as in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No LVRR &#40;n&#61;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVRR &#40;n&#61;39&#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">OR&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">CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;8&#177;14&#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">49&#46;2&#177;13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;84&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Male &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#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">66&#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">0&#46;85&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Hypertension &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#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">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&#8211;5&#46;4&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="elsevierStyleBold">NYHA class I &#40;&#37;&#41;</span>&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;6&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;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Heart rate &#40;bpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;6&#177;16&#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">83&#46;3&#177;19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Systolic blood pressure &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117&#46;0&#177;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">122&#46;7&#177;18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Atrial fibrillation &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#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">25&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&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;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&#8211;11&#46;8&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="elsevierStyleBold">QRS duration &#40;ms&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">131&#46;8&#177;32&#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">117&#46;1&#177;29&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&#8211;0&#46;98&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="elsevierStyleBold">LBBB &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#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">30&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&#8211;0&#46;9&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="elsevierStyleBold">LV hypertrophy &#40;&#37;&#41;</span>&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;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#8211;9&#46;0&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="6" 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="6" align="left" valign="top"><span class="elsevierStyleBold">Laboratory variables</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><span class="elsevierStyleItalic">Hematocrit &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#46;8&#177;4&#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">43&#46;2&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&#8211;1&#46;3&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><span class="elsevierStyleItalic">Creatinine clearance &#40;ml&#47;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&#46;7&#177;32&#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">107&#46;1&#177;29&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Uric acid &#40;mg&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&#177;30&#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">40&#46;4&#177;31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Na&#43; &#40;mEq&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#46;6&#177;2&#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">139&#46;7&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BNP &#40;pg&#47;ml&#41; &#40;median&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;0&#177;204&#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">26&#46;2&#177;1839&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48&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><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="6" 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="6" align="left" valign="top"><span class="elsevierStyleBold">Echocardiogram</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><span class="elsevierStyleItalic">LV ejection fraction &#40;&#37;&#41;</span>&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;0&#177;9&#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">28&#46;1&#177;8&#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">0&#46;46&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">RV dysfunction &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#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">7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LA diameter &#40;mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;1&#177;7&#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">44&#46;8&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LA volume&#47;BSA &#40;ml&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;1&#177;16&#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">37&#46;6&#177;11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;93&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LV diameter &#40;mm&#41;</span>&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;0&#177;9&#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">65&#46;1&#177;6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LV diameter&#47;BSA &#40;mm&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;0&#177;7&#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">35&#46;4&#177;4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&#8211;0&#46;99&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><span class="elsevierStyleItalic">LV mass&#47;BSA &#40;g&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337&#46;9&#177;109&#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">315&#46;8&#177;71&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Grade &#62;II&#47;IV mitral regurgitation &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#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">28&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PASP &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;9&#177;17&#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">39&#46;1&#177;13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">24-hour ECG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;32&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><td class="td" title="table-entry  " align="" valign="top">&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean HR &#40;24 hour ECG&#41; &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;2&#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">78&#46;1&#177;11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Non-sustained VT &#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;9&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;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&#8211;0&#46;9&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><span class="elsevierStyleHsp" style=""></span>SDNN &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101&#46;7&#177;38&#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">125&#46;7&#177;53&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">AT&#58; anaerobic threshold&#59; CI&#58; confidence interval&#59; CMR&#58; cardiac magnetic resonance&#59; CPET&#58; cardiopulmonary exercise testing&#59; EF&#58; ejection fraction&#59; LGE&#58; late gadolinium enhancement&#59; LV&#58; left ventricular&#59; LVRR&#58; left ventricular reverse remodeling&#59; OR&#58; odds ratio&#59; POUE&#58; peak oxygen uptake efficiency&#59; RV&#58; right ventricular&#59; VCO<span class="elsevierStyleInf">2</span>&#58; carbon dioxide output&#59; VE&#58; expired ventilatory flow&#59; VO<span class="elsevierStyleInf">2</span>&#58; oxygen uptake&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No LVRR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVRR&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">OR&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">CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CPET</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;14&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><td class="td" title="table-entry  " align="" valign="top">&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peak VO<span class="elsevierStyleInf">2</span> &#40;ml&#47;kg&#47;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">17&#46;6&#177;5&#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">19&#46;9&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#37;VO<span class="elsevierStyleInf">2</span> predicted &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;8&#177;17&#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">68&#46;4&#177;18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#37; VO<span class="elsevierStyleInf">2</span> at AT &#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">39&#46;1&#177;17&#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">43&#46;8&#177;13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VE&#47;CO<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">40&#46;9&#177;14&#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">35&#46;3&#177;7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20&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><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-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>&#47;VO<span class="elsevierStyleInf">2</span> peak&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;0&#177;3&#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">2&#46;5&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&#8211;1&#46;0&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>O<span class="elsevierStyleInf">2</span> pulse &#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">78&#46;9&#177;26&#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">84&#46;9&#177;23&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;46&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Circulatory power &#40;mmHg&#47;ml&#47;kg&#47;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">2415&#46;9&#177;866&#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">2893&#46;5&#177;914&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>POUE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">734&#46;0&#177;245&#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">979&#46;0&#177;181&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&#8211;1&#46;1&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>POUE at AT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">274&#46;9&#177;17&#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">327&#46;2&#177;80&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#916; HR recovery at 1 min &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;4&#177;8&#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">22&#46;9&#177;9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&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><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="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></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="elsevierStyleItalic">CMR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#61;14&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><td class="td" title="table-entry  " align="" valign="top">&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EF &#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;4&#177;10&#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">34&#46;4&#177;9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac index &#40;l&#47;min&#47;mm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;1&#177;0&#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">2&#46;9&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RV EF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;9&#177;1&#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">52&#46;3&#177;7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;23&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LGE &#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">58&#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">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LGE &#62;one segment &#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">50&#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">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Predictive factors of left ventricular reverse remodeling on cardiopulmonary exercise testing and cardiac magnetic resonance imaging&#46;</p>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac remodeling &#8211; concepts and clinical implications&#58; a consensus paper from an international forum on cardiac remodeling&#46; Behalf of an International Forum on Cardiac Remodeling"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;N&#46; Cohn"
                            1 => "R&#46; Ferrari"
                            2 => "N&#46; Sharpe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "35"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted anticytokine therapy in patients with chronic heart failure&#58; results of the Randomized Etanercept Worldwide Evaluation &#40;RENEWAL&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Mann"
                            1 => "J&#46; McMurray"
                            2 => "M&#46; Packer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000124490.27666.B2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2004"
                        "volumen" => "109"
                        "paginaInicial" => "1594"
                        "paginaFinal" => "1602"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15023878"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy in mild heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Linde"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eup307"
                      "Revista" => array:7 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2009"
                        "volumen" => "11"
                        "numero" => "Suppl&#46; 5"
                        "paginaInicial" => "v72"
                        "paginaFinal" => "v76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19861394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac resynchronization therapy for the prevention of heart-failure events"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Moss"
                            1 => "W&#46;J&#46; Hall"
                            2 => "D&#46;S&#46; Cannom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0906431"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1329"
                        "paginaFinal" => "1338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723701"
                            "web" => "Medline"
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