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It also serves as a good prognostic marker and has been studied in patients with infectious diseases&#44; as well as in cases of oncological&#44; hematological&#44; immunological&#44; and cardiac disorders&#44; using a complete blood count&#44; the most commonly performed test in hospitals&#46; Previous research has revealed that it has significant prognostic value&#44; in addition to various positive correlations&#46; The predictive value of NLR in peripheral arterial disease and calcific aortic stenosis&#44; as well as in prognostication of the presence&#44; severity&#44; and extent of coronary artery disease&#44; heart failure&#44; and many other cardiovascular disorders has already been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> A high NLR is associated with poor prognosis in the majority of studies&#46; Although the relationship between NLR and almost all cardiovascular disorders has been investigated&#44; the importance of NLR in HCM remains unclear&#46; To the best of our knowledge&#44; few studies have been conducted on the prognostic significance of the correlation between NLR and HCM&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study&#44; we aimed to assess whether the presence of high NLR is associated with poor prognosis in HCM and whether NLR is associated with echocardiographic parameters&#44; cardiac arrhythmia&#44; or predicted five-year risk of SCD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0020" class="elsevierStylePara elsevierViewall">This prospective observational study included a consecutive sample of 97 patients with HCM and 74 age- and gender-matched controls without HCM who presented to Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center&#44; Training and Research Hospital&#44; and to the School of Medicine at Bezmialem Vakif University&#44; between December 2012 and November 2015&#46; Three years of follow-up results of patients with HCM were evaluated&#46; The study was approved by the ethics committee of the School of Medicine at Bezmialem Vakif University&#44; and all participants gave their written informed consent&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study inclusion criteria were age &#62;17 years and echocardiography or cardiac magnetic resonance imaging &#40;CMRI&#41; revealing HCM&#44; defined as left ventricular &#40;LV&#41; wall thickness of at least 15 mm in one or more LV myocardial segments&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In those with lesser degrees of wall thickening &#40;13-14 mm&#41; with a high possibility of HCM&#44; we evaluated other factors&#44; including family history&#44; positive gene mutations&#44; and abnormalities on the electrocardiogram &#40;ECG&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with hypertension &#40;n&#61;8&#41;&#44; renal failure &#40;n&#61;2&#41;&#44; history of myocardial infarction &#40;n&#61;1&#41;&#44; aortic valve stenosis &#40;n&#61;1&#41;&#44; and active inflammation or chronic inflammatory diseases &#40;n&#61;2&#41;&#44; were excluded from the study&#44; resulting in a final population of 97 patients&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Electrocardiography</span><p id="par0035" class="elsevierStylePara elsevierViewall">A resting 12-lead surface ECG was obtained from all patients while in the supine position&#46; The ECG recordings were made on a Nihon Kohden Cardiofax S ECG-1250K &#40;filter range 0&#46;5-150 Hz&#44; AC filter 60 Hz&#44; at a speed of 25 mm&#47;s and an amplitude of 10 mm&#47;mV&#41; at the first visit&#46; Cardiac rhythm&#44; heart rate&#44; the presence of fragmented QRS &#40;fQRS&#41; and QRS&#44; QT&#44; and corrected QT &#40;QTc&#41; interval were determined&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fragmented QRS</span><p id="par0040" class="elsevierStylePara elsevierViewall">The presence or absence of fQRS on the ECGs was assessed by two independent readers blinded to both cardiac markers and clinical outcomes&#46; Interobserver agreement with regard to detection of fQRS was 96&#46;8&#37; &#40;j&#61;0&#46;93&#41; between the two readers and intraobserver agreement was 98&#46;9&#37; &#40;j&#61;0&#46;97&#41;&#46; If the observers could not reach an agreement&#44; a third independent observer was included in the decision-making&#44; and an agreement between two of the three observers was accepted as the final decision&#46; fQRS was defined as the presence of an extra R wave &#40;R1&#41; on a 12-lead ECG&#44; notching on an R wave&#44; notching on an S wave&#44; or the presence of more than one R1 wave in two adjacent leads corresponding to the territory of one of the major coronary arteries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Complete and incomplete bundle branch block and paced rhythm were excluded from the definition of fQRS&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Echocardiography</span><p id="par0045" class="elsevierStylePara elsevierViewall">On admission to the hospital&#44; participants underwent transthoracic echocardiographic studies using a Vivid S5 and a 3S-RS probe &#40;GE Healthcare&#41; with a 1&#46;7&#47;3&#46;4 MHz phased-array transducer&#46; All echocardiographic parameters were measured off-line based on an average of three cardiac cycles&#46; LV ejection fraction &#40;LVEF&#41; was calculated using the biplane Simpson method&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> LV wall thickness &#40;interventricular septum&#44; posterior wall&#41;&#44; LV end-diastolic diameter &#40;LVEDD&#41;&#44; and LV end-systolic diameter &#40;LVESD&#41; were measured in parasternal long-axis view&#46; The LV outflow tract gradient was measured in apical 5-chamber view&#46; In addition&#44; LVEDD&#44; LVESD&#44; left atrial &#40;LA&#41; diameter&#44; LA volume&#44; LA volume index &#40;LAVI&#41;&#44; LV mass &#40;LVM&#41;&#44; LV mass index &#40;LVMI&#41;&#44; mitral valve regurgitation and systolic anterior motion of the mitral valve&#44; relative wall thickness index &#40;RWTI&#41;&#44; and LV diastolic dysfunction were assessed&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Holter ambulatory electrocardiographic monitoring</span><p id="par0050" class="elsevierStylePara elsevierViewall">Holter 12-lead 24-hour records &#40;DMS 300-7 Holter recorder&#44; DM Software&#44; Stateline&#44; NV&#44; USA&#41; were obtained from all patients and analyzed automatically using CardioScan 12&#46;0 &#40;DM Software&#41;&#46; The recordings were analyzed for rhythm&#44; premature atrial contractions&#44; supraventricular tachycardia &#40;VT&#41;&#44; paroxysmal atrial fibrillation&#44; premature ventricular contractions&#44; nonsustained and&#47;or sustained VT&#44; and atrioventricular block with pauses&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Assessment of five-year risk of sudden cardiac death</span><p id="par0055" class="elsevierStylePara elsevierViewall">An individual patient&#39;s five-year risk of SCD was calculated using the following equation&#44; proposed by O&#8217;Mahony et al&#46;&#44; based on Cox proportional hazards analysis of age&#44; non-sustained VT&#44; maximum LV wall thickness&#44; family history of SCD&#44; LA diameter&#44; unexplained syncope&#44; and LV outflow tract gradient&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia>where S0&#40;t&#41; is the average survival probability at time t &#40;i&#46;e&#46;&#44; at five years&#41; and the prognostic index is the sum of the products of the predictors and their coefficients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Five-year SCD risk calculation was performed for each patient at the first visit and was repeated if there were any changes in the patient&#39;s clinical status or Holter and echocardiography results&#46; Patients were divided into two groups based on their predicted risk&#44; &#8804;6&#37; or &#62;6&#37;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Biochemical analyses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Peripheral venous blood samples were obtained from all study participants during the first outpatient clinic visit and collected in K3 EDTA tubes&#46; Hematologic indices were calculated from the complete blood count&#44; which was performed using a XT-2000i analyzer &#40;Sysmex Corporation of America&#44; Long Grove&#44; IL&#44; USA&#41;&#46; NIR was calculated by dividing the neutrophil count by the lymphocyte count&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using SPSS version 15 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Continuous variables were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Categorical variables were expressed as frequencies and percentages&#46; Samples were compared using the Kolmogorov-Smirnov test&#46; Because the distribution of data was parametric&#44; Student&#39;s t tests were performed&#46; A Pearson&#39;s correlation coefficient analysis was performed to evaluate the relationship between the two types of quantitative data&#46; The Student&#39;s t test was used to compare data obtained from the groups&#44; and chi-square tests were performed to compare rates between the groups&#46; A p value of <span class="elsevierStyleItalic">&#60;</span>0&#46;05 was accepted as statistically significant&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study endpoints and follow-up</span><p id="par0080" class="elsevierStylePara elsevierViewall">On admission&#44; patients&#8217; medical history&#44; family history of SCD&#44; occurrence of syncope&#44; and responses to a questionnaire on lifestyle and risk factors were recorded&#46; Patients were regularly followed during visits to the HCM outpatient clinic at three-month intervals and any change in clinical status was noted&#46; ECG was performed every three months and 24-hour Holter monitoring was performed at least once in all patients&#44; and at least twice in those with more than one risk factor for SCD&#46; Twenty-four-hour Holter monitoring or telemetry was also performed when patients had any potentially arrhythmic symptoms&#44; including dizziness&#44; light-headedness&#44; palpitations&#44; or syncope&#46; The primary endpoint for the study was occurrence of a ventricular arrhythmic event and the secondary endpoint was occurrence of a major arrhythmic event&#46; Follow-up for clinical endpoints was performed by telephone interview and review of outpatient and inpatient medical records&#46; The mean follow-up period was 34&#46;95&#177;10&#46;23 months&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 97 patients &#40;58 male and 39 female&#41; with HCM comprised the patient group&#44; and the control group consisted of 74 age- and gender-matched subjects without HCM &#40;29 male and 45 female&#41;&#46; The participants&#8217; demographic and clinical characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no significant differences between the patient and control groups with regard to age&#44; gender&#44; or body mass index&#46; Hypertension&#44; hyperlipidemia&#44; diabetes&#44; smoking&#44; and total cholesterol were not statistically different between the two groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Medical treatments administered to participants in the patient and control groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Values of NRL&#44; LVMI&#44; nonsustained VT&#44; LA diameter&#44; peak LVOTG&#44; RWTI&#44; and syncope were significantly higher in the patient group than in the control group &#40;2&#46;0&#177;1&#46;3 vs&#46; 1&#46;3&#177;0&#46;3&#44; p&#60;0&#46;001&#59; 178&#177;48 vs&#46; 77&#177;18 g&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#60;0&#46;001&#59; 16 &#91;16&#46;5&#37;&#93; vs&#46; 0&#44; p&#60;0&#46;001&#59; 42&#177;4&#46;7 vs&#46; 34&#46;6&#177;3&#46;3 mm&#44; p&#60;0&#46;001&#59; 40&#177;38 vs&#46; 0 mmHg&#59; 0&#46;62&#177;0&#46;24 vs&#46; 0&#46;39&#177;0&#46;05&#44; p&#60;0&#46;001&#59; and 11 &#91;11&#46;3&#37;&#93; vs&#46; 0&#44; p&#60;0&#46;003&#44; respectively&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Comparisons of NRL between the groups according to fQRS&#44; LVEF&#44; VT&#44; five-year SCD risk&#44; QTc&#44; syncope&#44; and presyncope in patients with HCM are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#46; NLR was significantly higher in patients with fQRS&#44; VT&#44; and presyncope than in those without &#40;fQRS &#91;n&#61;59&#93;&#44; NLR&#58; 2&#46;2&#177;1&#46;6 vs&#46; no fQRS &#91;n&#61;38&#93;&#44; NLR&#58; 1&#46;6&#177;0&#46;4&#44; p&#61;0&#46;031&#59; VT &#91;n&#61;16&#93;&#44; NLR&#58; 2&#46;7&#177;2&#46;6 vs&#46; no VT &#91;n&#61;81&#93;&#44; NLR&#58; 1&#46;9&#177;0&#46;8&#44; p&#61;0&#46;030&#59; presyncope &#91;n&#61;28&#93;&#44; NLR&#58; 2&#46;5&#177;2&#46;1 vs&#46; no presyncope &#91;n&#61;69&#93;&#44; NLR&#58; 1&#46;8&#177;0&#46;7&#44; p&#61;0&#46;020&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>a&#44; c and f&#41;&#46; NLR was significantly higher in patients whose left ventricular ejection fraction &#40;LVEF&#41; was &#60;60&#37; &#40;LVEF &#8804;59&#46;9&#37; &#91;n&#61;16&#93;&#44; NLR&#58; 2&#46;7&#177;2&#46;7 vs&#46; LVEF &#62;60&#37; &#91;n&#61;81&#93;&#44; NLR&#58; 1&#46;9&#177;0&#46;7&#44; p&#61;0&#46;017&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>b&#41;&#46; NLR was significantly higher in patients whose predicted five-year risk of SCD was over 6&#37; and whose QTc interval was greater than 440 ms &#40;predicted five-year SCD risk &#62;6&#37; &#91;n&#61;39&#93;&#44; NLR&#58; 2&#46;4&#177;1&#46;8 vs&#46; &#8804;5&#46;9&#37; &#91;n&#61;57&#93;&#44; NLR&#58; 1&#46;8&#177;0&#46;6&#44; p&#61;0&#46;022&#59; QTc &#62;440 ms &#91;n&#61;35&#93;&#44; NLR&#58; 2&#46;7&#177;1&#46;9 vs&#46; &#8804;439 ms &#91;n&#61;62&#93;&#44; NLR&#58; 1&#46;6&#177;0&#46;5&#44; p&#61;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>d and e&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Correlations between NLR and demographic findings&#44; biochemical parameters&#44; acute phase reactants&#44; and echocardiographic results are presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>&#46; A statistically significant correlation was found only between QTc and NLR &#40;r&#61;0&#46;251&#44; p&#61;0&#46;013&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study&#44; we investigated whether NLR could be a predictor of cardiac events&#46; The study&#39;s most important findings are the following&#58; &#40;1&#41; NLR was significantly higher in HCM patients compared to age- and gender-matched controls&#59; &#40;2&#41; a high NLR appears to be associated with ventricular arrhythmic events in patients with HCM&#59; &#40;3&#41; NLR was significantly associated with QTc interval&#59; &#40;4&#41; a high NLR appears to be associated with the presence of fQRS&#59; and &#40;5&#41; NLR appears to be significantly higher in the high-risk group&#44; those who demonstrated a predicted SCD risk of over 6&#37;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the past few years&#44; several studies have been conducted on NLR in patients with both cardiac and noncardiac diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Activated neutrophils represent nonspecific systemic inflammation&#44; and lymphocytes are a marker of the immune system physiological stress response&#46; NLR integrates these two important and opposite immune pathways&#44; and thus serves as a measure of both systemic inflammation and stress response&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A high NLR has been associated with poor prognosis in most of these studies&#46; In particular&#44; inflammation plays a key role in the initiation and progression of cardiovascular disease&#46; A previous study showed a correlation between NLR and severity of chronic heart failure&#46; NLR may reflect increased sympathetic drive&#44; and therefore oxidative stress and cytokine production&#44; because of the possible influence of the autonomic nervous system on leukocyte subtype distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Activated neutrophils are known to play a direct role by adhering to and penetrating the ventricular myocardium and releasing reactive oxygen species&#44; cytokines&#44; and hydrolytic enzymes&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This leads to extracellular matrix remodeling and reparative processes&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> It was perhaps for this reason that LVEF was under 60&#37; in patients with high NLR in the present study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The precise mechanism of this inflammatory pathway remains unknown&#59; systemic inflammation can lead to infiltration of the myocardium with inflammatory cells&#44; and this condition may cause irregular interstitial fibrosis in atrial and ventricular tissue&#46; Relationships have been demonstrated between the development of atrial fibrillation and interleukin 8&#44; interleukin 6 &#40;IL-6&#41; and high-sensitivity C-reactive protein &#40;hs-CRP&#41; levels&#44; and increased white blood cell &#40;WBC&#41; count&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Leukocytes release pro-inflammatory cytokines&#44; such as tumor necrosis factor-alpha&#44; IL-6&#44; and C-reactive protein&#44; and can activate neutrophils to release a variety of proteolytic enzymes such as myeloperoxidase&#44; acid phosphatase&#44; and elastase&#44; which facilitate increased tissue destruction and can lead to direct deleterious effects on the myocardium&#44; resulting in irregular fibrous thickening and the formation of arrhythmia foci in the ventricles&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> NLR has been linked to increased risk of ventricular arrhythmias during percutaneous coronary intervention &#40;PCI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Chatterjee et al&#46; reported that pre-procedural elevated WBC count&#44; neutrophilia&#44; and elevated NLR were significant predictors of ventricular arrhythmia in patients undergoing PCI&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the present study&#44; NLR was higher in patients with VT&#44; a finding consistent with previous studies&#46; This result suggests that more attention should be paid to the possibility of ventricular arrhythmias in patients with high NLR&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The role of QT and QTc prolongation and fQRS in HCM patients has been studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> Changes in the myocardium caused by LVH lead to heterogeneity in action potentials and to increased duration of repolarization&#46; These result in an increase in QT or QTc interval&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Kulan et al&#46; demonstrated a significant relation between QTc interval and LVH&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Similarly&#44; Gray et al&#46; showed that a QTc interval &#8805;439 ms&#44; independently of the presence of conventional risk factors&#44; predicts appropriate implantable cardioverter-defibrillator &#40;ICD&#41; therapies in HCM patients&#44; with a more than three-fold increase in the risk of appropriate therapies compared to those without prolonged QT&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> It is possible that a separate mechanism &#40;e&#46;g&#46; myocardial fibrosis&#41; may account for QTc prolongation in HCM&#46; In the present study&#44; we observed longer QTc intervals in patients with high NLR&#46; Likewise&#44; it is known that fQRS complexes in multiple ECG leads are associated with myocardial scarring or fibrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;16</span></a> Such changes in the myocardium may lead to heterogeneous ventricular activation&#44; which could manifest as fQRS on ECG&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;20</span></a> Fractionated electrograms consisting of multiple discrete deflections have been observed in regions where islands of viable myocardial tissue are interspersed with abundant fibrous tissue&#46; In the present study&#44; NLR was significantly higher in patients with fQRS&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The current European guidelines on HCM recommend a practical risk prediction model for SCD in patients with HCM&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This model&#44; known as HCM Risk-SCD&#44; is relatively simple and easy to calculate and helps guide therapeutic decision-making&#46; According to this method&#44; a predicted five-year SCD risk of over 6&#37; indicates that the patient is at high risk and an ICD should be considered&#46; In the present study&#44; we observed that NLR was significantly higher in patients with a predicted five-year SCD risk over 6&#37;&#46; As discussed above&#44; nonsustained VT caused by irregular myocardial fibrosis may be responsible for higher SCD risk&#46; Our findings indicate that five-year SCD risk may be higher in patients with high NLR&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Study limitations</span><p id="par0130" class="elsevierStylePara elsevierViewall">This was not an epidemiological or randomized study&#46; The sample size &#40;n&#61;97&#41; of HCM patients was relatively small&#46; We included only adult HCM patients&#59; elite athletes and individuals with metabolic diseases &#40;e&#46;g&#46; Anderson-Fabry disease&#41; and relevant syndromes &#40;e&#46;g&#46; Noonan syndrome&#41; were excluded&#46; Inflammatory parameters such as IL-6&#44; tumor necrosis factor-alpha&#44; hs-CRP&#44; and myeloperoxidase were not simultaneously measured and compared with NLR because they are generally not available in daily practice&#46; We were unable to examine all of our patients with CMRI because some patients had pacemakers and some refused to participate&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">It is well known that inflammation contributes to progression of cardiac dysfunction and plays a role in worsening of clinical status&#46; Calculation of NLR is a noninvasive&#44; inexpensive&#44; and readily available tool&#46; NLR was significantly higher in patients with HCM compared to the control group&#46; A high NLR is associated with a higher five-year risk of SCD in patients with HCM&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Protection of human and animal subjects</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Confidentiality of data</span><p id="par0145" 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="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Right to privacy and informed consent</span><p id="par0150" 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="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Echocardiography"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Holter ambulatory electrocardiographic monitoring"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Assessment of five-year risk of sudden cardiac death"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Biochemical analyses"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Statistical analysis"
            ]
            8 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Study endpoints and follow-up"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Study limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conclusions"
        ]
        10 => array:3 [
          "identificador" => "sec0080"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Funding"
        ]
        12 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflicts of interest"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-04-20"
    "fechaAceptado" => "2016-09-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec821491"
          "palabras" => array:3 [
            0 => "Hypertrophic cardiomyopathy"
            1 => "Neutrophil-to-lymphocyte ratio"
            2 => "Five-year risk of sudden cardiac death"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec821490"
          "palabras" => array:3 [
            0 => "Miocardiopatia hipertr&#243;fica"
            1 => "Rela&#231;&#227;o neutr&#243;filos&#47;linf&#243;citos"
            2 => "<span class="elsevierStyleItalic">Score</span> de risco a cinco anos de morte s&#250;bita card&#237;aca"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio &#40;NLR&#41; in many cardiovascular disorders&#46; The aim of this study was to assess whether NLR is associated with echocardiographic or electrocardiographic parameters&#44; or with predicted five-year risk of sudden cardiac death &#40;SCD&#41;&#44; in patients with hypertrophic cardiomyopathy &#40;HCM&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This prospective observational study included 74 controls and 97 HCM patients&#46; Three years of follow-up results for HCM patients were evaluated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">NLR was significantly higher in patients with fragmented QRS&#44; ventricular tachycardia&#44; and presyncope than in those without &#40;p&#61;0&#46;031&#44; 0&#46;030&#44; and 0&#46;020&#44; respectively&#41;&#46; NLR was significantly higher in patients whose predicted five-year risk of SCD was more than 6&#37; and whose corrected QT interval was greater than 440 ms &#40;p&#61;0&#46;022 and 0&#46;001&#44; respectively&#41;&#46; It was also significantly higher in patients whose left ventricular ejection fraction &#40;LVEF&#41; was &#60;60&#37; than in those with LVEF &#62;60&#37; &#40;p&#61;0&#46;017&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">NLR was significantly higher in patients with HCM compared to the control group&#46; A high NLR is associated with a higher five-year risk of SCD in patients with HCM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudos pr&#233;vios demonstraram o valor preditivo da rela&#231;&#227;o neutr&#243;filos&#47;linf&#243;citos &#40;RNL&#41; em muitas altera&#231;&#245;es cardiovasculares&#46; O objetivo deste estudo foi avaliar se a RNL est&#225; associada a par&#226;metros ecocardiogr&#225;ficos ou eletrocardiogr&#225;ficos&#44; ou com o <span class="elsevierStyleItalic">score</span> de risco de morte s&#250;bita card&#237;aca &#40;MSC&#41; a cinco anos em doentes com miocardiopatia hipertr&#243;fica &#40;MCH&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo prospetivo observacional incluiu 74 controlos e 97 doentes com MCH&#46; Foram avaliados os resultados dos doentes com MCH ao longo de tr&#234;s anos de seguimento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O valor da RNL foi significativamente superior nos doentes com QRS fragmentado&#44; com taquicardia ventricular e com pr&#233;-s&#237;ncope do que nos que n&#227;o revelaram esses sinais &#40;valores p&#58; 0&#44;031&#44; 0&#44;030&#44; 0&#44;020&#44; respetivamente&#41;&#46; O valor RNL foi estat&#237;stica e significativamente superior nos doentes com risco de MSC previs&#237;vel a cinco anos superior a 6&#37;&#44; e com um intervalo QT corrigido superior a 440<span class="elsevierStyleHsp" style=""></span>ms &#40;valores p&#58; 0&#44;022&#44; 0&#44;001&#44; respetivamente&#41;&#46; O valor da RNL foi significativamente superior nos doentes com fra&#231;&#227;o de eje&#231;&#227;o &#40;FE&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#37; do que nos doentes com FE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60&#37; &#40;valor p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A RNL foi significativamente superior nos doentes com MCH quando comparada com o grupo controlo&#46; Uma RNL alta est&#225; associada a um <span class="elsevierStyleItalic">score</span> de risco de MSC elevado aos cinco anos em doentes com MCH&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2439
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            "Tamanyo" => 337758
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Neutrophil-to-lymphocyte ratio and &#40;a&#41; fragmented QRS&#44; &#40;b&#41; ejection fraction&#44; &#40;c&#41; ventricular tachycardia&#44; &#40;d&#41; predicted five-year risk of sudden cardiac death&#44; &#40;e&#41; corrected QT&#44; and &#40;f&#41; presyncope in patients with hypertrophic cardiomyopathy&#46; fQRS&#58; fragmented QRS&#59; LVEF&#58; left ventricular ejection fraction&#59; NLR&#58; neutrophil-to-lymphocyte ratio&#59; QTc&#58; corrected QT interval&#59; SCD&#58; sudden cardiac death&#59; VT&#58; ventricular tachycardia&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; BMI&#58; body mass index&#59; CCBs&#58; calcium channel blockers&#59; LA&#58; left atrial&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVOTG&#58; left ventricular outflow gradient at rest&#59; LVMI&#58; left ventricular mass index&#59; NLR&#58; neutrophil-to-lymphocyte ratio&#59; NSVT&#58; nonsustained ventricular tachycardia&#59; NYHA&#58; New York Heart Association&#59; RWT&#58; relative wall thickness index&#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">Patient group&#44; n &#40;&#37;&#41; or mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&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">Control group&#44; n &#40;&#37;&#41; or mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No&#46; of patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male &#40;n&#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">58 &#40;59&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;43&#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">0&#46;053&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">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">47&#46;6&#177;15&#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">45&#46;0&#177;8&#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;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;1&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;8&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;169&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 III or IV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;25&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;00&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">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;7&#46;2&#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">11 &#40;14&#46;9&#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">0&#46;133&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">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;17&#46;6&#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">0&#46;015&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">Hyperlipidemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;22&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;19&#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">0&#46;576&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">Total cholesterol &#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">184&#46;6&#177;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">193&#177;34&#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;137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoking</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 &#40;21&#46;6&#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">22 &#40;29&#46;7&#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">0&#46;286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Medical therapy&#44; n &#40;&#37;&#41;</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>Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;91&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;18&#46;9&#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">&#60;0&#46;00&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>CCBs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;2&#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">6 &#40;8&#46;1&#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">0&#46;534&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>Amiodarone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;4&#46;1&#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">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;134&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>Disopyramide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;8&#46;2&#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">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;10&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">Paroxysmal AF &#40;n&#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">3 &#40;3&#46;1&#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">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;259&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">NLR</span>&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;0&#177;1&#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">1&#46;3&#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">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEF &#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">66&#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">65&#46;2&#177;7&#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;01&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">LVMI &#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">178&#177;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#177;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NSVT &#40;n&#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">16 &#40;16&#46;5&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><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">42&#177;4&#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">34&#46;6&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peak LVOTG &#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">40&#177;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEDD &#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">43&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#177;3&#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;41&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">RWTI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;62&#177;0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;39&#177;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">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Syncope &#40;n&#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">11 &#40;11&#46;3&#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">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;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Baseline and clinical characteristics of patient and control groups&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">fQRS&#58; fragmented QRS&#59; HCM&#58; hypertrophic cardiomyopathy&#59; LVEF&#58; left ventricular ejection fraction&#59; NLR&#58; neutrophil-to-lymphocyte ratio&#59; QTc&#58; corrected QT interval&#59; SCD&#58; sudden cardiac death&#59; VT&#58; ventricular tachycardia&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NLR&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;031</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;-&#41; &#40;n&#61;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">LVEF &#40;&#37;&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#62;60 &#40;n&#61;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;017</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8804;59&#46;9 &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#177;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">VT</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#43;&#41; &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#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  " rowspan="2" align="char" valign="middle">0&#46;030</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;-&#41; &#40;n&#61;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&#177;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">Predicted five-year SCD risk</td><td class="td" title="table-entry  " align="left" valign="top">&#62;&#37;6 &#40;n&#61;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&#177;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;022</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8804;&#37;5&#46;9 &#40;n&#61;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8&#177;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">QTc</td><td class="td" title="table-entry  " align="left" valign="top">&#62;440 &#40;n&#61;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#177;1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8804;439 &#40;n&#61;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">Syncope</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#43;&#41; &#40;n&#61;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;487</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;-&#41; &#40;n&#61;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;0&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">Presyncope</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#43;&#41; &#40;n&#61;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;020</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;-&#41; &#40;n&#61;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Neutrophil-to-lymphocyte ratio according to fragmented QRS&#44; ejection fraction&#44; ventricular tachycardia&#44; five-year risk of sudden cardiac death&#44; corrected QT&#44; syncope&#44; and presyncope in patients with hypertrophic cardiomyopathy&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at3"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; BSA&#58; body surface area&#59; CRP&#58; C-reactive protein&#59; ESR&#58; erythrocyte sedimentation rate&#59; IVS&#58; interventricular septum&#59; LA&#58; left atrial&#59; LAVI&#58; left atrial volume index&#59; LV&#58; left ventricular&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; left ventricular end-systolic diameter&#59; LVMI&#58; left ventricular mass index&#59; LVOTG&#58; left ventricular outflow tract gradient&#59; MPV&#58; mean platelet volume&#59; NLR&#58; neutrophil-to-lymphocyte ratio&#59; QTc&#58; corrected QT interval&#59; PWT&#58; posterior wall thickness&#59; RWTI&#58; relative wall thickness index&#59; SCD&#58; sudden cardiac death&#59; SD&#58; standard deviation&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">In bold&#44; statistically significant correlations between the QTc and NLR&#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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">NLR &#40;mean 2&#46;0&#177;1&#46;3&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galectin 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7138&#46;9&#177;2211&#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;174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Predicted five-year SCD risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;089&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;390&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">QRS interval &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&#46;4&#177;22&#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;139&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;175&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">QTc &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">423&#46;7&#177;55&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;251</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;013</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;0&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;006&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;951&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">BSA &#40;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;087&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;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA anteroposterior 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">42&#46;0&#177;4&#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;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA mediolateral 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">46&#46;1&#177;6&#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;076&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;459&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">LAVI &#40;ml&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;9&#177;12&#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;091&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;377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA apicobasal 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">52&#46;9&#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;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uric acid &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&#177;1&#46;36&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;085&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;412&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF &#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">65&#46;9&#177;7&#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;178&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;080&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVS &#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">21&#46;6&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;097&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;345&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">PWT &#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">12&#46;9&#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;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDD &#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">43&#46;0&#177;5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;127&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;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVESD &#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">25&#46;5&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;112&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;273&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">LV mass &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">330&#46;9&#177;79&#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;008&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;938&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVMI &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177&#46;9&#177;48&#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;014&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;891&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">RWTI&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;6&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&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;998&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">Age &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;8&#177;15&#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;023&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;825&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">LVOTG at rest &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;6&#177;28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;109&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;288&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">LVOTG with Valsalva &#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">40&#46;6&#177;38&#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;187&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;067&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">MPV &#40;fl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2&#177;1&#46;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;003&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;975&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">CRP &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&#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;193&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;059&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">ESR &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;1&#177;14&#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;256&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;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy&#58; the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology &#40;ESC&#41;"
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                      "doi" => "10.1093/eurheartj/ehu284"
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                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
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                      "titulo" => "Prognostic significance of an elevated neutrophil-lymphocyte ratio in the amputation-free survival of patients with chronic critical limb ischemia"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Gonz&#225;lez-Fajardo"
                            1 => "J&#46;A&#46; Brizuela-Sanz"
                            2 => "B&#46; Aguirregerv&#225;s"
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                    0 => array:2 [
                      "doi" => "10.1016/j.avsg.2013.06.037"
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                        "tituloSerie" => "Ann Vasc Surg"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "999"
                        "paginaFinal" => "1004"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24559786"
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                      "titulo" => "Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality&#58; insights from the National Health And Nutrition Examination Survey-III"
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                          "etal" => true
                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2013.12.019"
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                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "171"
                        "paginaInicial" => "390"
                        "paginaFinal" => "397"
                        "link" => array:1 [
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                      "titulo" => "Classification of the cardiomyopathies&#58; a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehm342"
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                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "270"
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                      "titulo" => "Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease"
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