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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">Atherosclerosis is a prevalent cardiovascular disease characterized by inflammation and plaque formation within arterial walls&#46; By means of coronary angiography&#44; it is possible to visualize the contours of the epicardial coronary arterial tree in vivo&#46; However&#44; abnormalities in the function and structure of coronary microcirculation deserve additional attention&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Vascular endothelial cells are exposed to hemodynamic forces &#40;including hydrostatic pressure&#44; cyclic stretch&#44; and fluid shear stress&#41;&#44; which modulate the functions of these cells in health and disease&#46; Flow patterns and hemodynamic forces in the vascular system are not uniform&#46; In straight parts of the arterial tree&#44; high shear stress upregulates genes that are protective against atherosclerosis under sustained laminar blood flow&#59; however&#44; in branches and curvatures the nonuniform and irregular blood distribution of low shear stress induces genes that promote endothelial abnormalities and atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Whole blood viscosity &#40;WBV&#41; is the intrinsic resistance of blood flow in vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Factors including hematocrit&#44; total plasma protein&#44; erythrocyte aggregation&#44; and erythrocyte deformability may influence WBV&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Studies have shown that elevated WBV may promote endothelial shear stress&#44; endothelial inflammation&#44; and vascular remodeling&#44; and can accelerate the atherosclerotic process&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study is twofold&#46; The first is to compare WBV levels in patients with microvascular angina &#40;MVA&#41;&#44; patients with coronary artery disease &#40;CAD&#41;&#44; and normal controls&#46; The second is to identify the relationship between WBV and high-sensitivity C-reactive protein &#40;hs-CRP&#41; as a marker of inflammation in CAD and MVA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 3160 patients undergoing diagnostic coronary angiography between February 2016 and December 2017 were analyzed retrospectively&#46; Of these&#44; 573 patients for whom hs-CRP and WBV parameters were available were selected for the current study&#46; The MVA group consisted of 189 subjects &#40;93 men&#44; mean age 58&#46;1&#177;8&#46;7 years&#41; with anginal chest pain but a normal coronary angiogram&#44; the CAD group consisted of 203 subjects &#40;105 men&#44; mean age 59&#46;3&#177;6&#46;9 years&#41;&#44; and the control group included 181 age- and gender-matched individuals &#40;96 men&#44; mean age 59&#46;7&#177;7&#46;2 years&#41; without known cardiac disease or signs of inducible ischemia on myocardial perfusion scintigraphy or treadmill exercise test&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with valvular heart disease&#44; heart failure&#44; cardiomyopathy&#44; hematological disease &#40;including anemia&#41;&#44; cancer&#44; active or chronic infectious or inflammatory disease&#44; autoimmune disease&#44; or other neurological or musculoskeletal disorders were excluded&#46; Informed consent was obtained from all patients before noninvasive and invasive protocols&#46; The study was approved by the local ethics committee&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All subjects underwent a detailed medical history&#44; physical examination&#44; and biochemical and hematological tests&#46; After the physical examination patients underwent treadmill exercise testing and myocardial perfusion testing&#46; If these tests revealed myocardial ischemia&#44; the patients were enrolled for coronary angiography&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients performed a typical Bruce or modified Bruce protocol test in accordance with recent guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Symptoms&#44; baseline and peak heart rate&#44; age-predicted maximum heart rate &#40;APMHR&#41;&#44; baseline and maximum blood pressure&#44; rhythm abnormalities&#44; and maximum ST deviation were assessed and the Duke treadmill score was calculated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Endpoints for termination of the exercise test were clinically significant ST-segment changes &#40;&#62;2 mm depression in two contiguous leads measured 80 ms after the J point&#41;&#44; worsening angina&#44; clinically significant arrhythmias&#44; drop in systolic blood pressure with increasing workload&#44; signs of poor perfusion&#44; or achievement of the APMHR without such disturbances&#46; In patients with a borderline or nondiagnostic treadmill exercise test&#44; stress perfusion imaging with single-photon emission computed tomography was performed with a single-head gamma camera equipped with a general purpose&#44; low-energy high-resolution parallel hole collimator &#40;Orbiter 400&#44; Siemens AG&#41;&#44; using either TL-201 or Tc-99m in accordance with the relevant guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Patients with pathologic treadmill exercise or myocardial perfusion tests were referred for coronary angiography&#44; which was performed using the Judkins method&#44; with a femoral artery approach&#46; Patients in whom coronary angiography revealed no visible disease or luminal irregularities &#40;less than 50&#37;&#41;&#44; according to a consensual decision between three experienced cardiologists&#44; were included in the MVA group&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">MVA was diagnosed on the basis of typical effort-induced angina-like discomfort associated with either transient ischemic ST-segment depression &#40;&#8805;1 mm&#41; during the treadmill exercise test &#40;93 patients&#41; or reversible perfusion defects on myocardial perfusion scintigraphy &#40;96 patients&#41; with angiographically normal coronary arteries and without coronary artery spasm&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the CAD group&#44; coronary lesions with &#8805;50&#37; stenosis in vessels of diameter &#8805;1&#46;5 mm were considered&#46; The Gensini and SYNergy between PCI with TAXUS and Cardiac Surgery &#40;SYNTAX&#41; scores were used to determine the extent and severity of CAD&#46; The online calculator was used for the SYNTAX scores &#40;<a href="http://www.syntaxscore.com/">www&#46;syntaxscore&#46;com</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The Gensini score grades stenosis in the epicardial coronary arteries as 1 for 1-25&#37; stenosis&#44; 2 for 26-50&#37;&#44; 4 for 51-75&#37;&#44; 8 for 76-90&#37;&#44; 16 for 91-99&#37;&#44; and 32 for total occlusion&#46; This score is then multiplied by a factor from 0&#46;5 to 5 taking into account the importance of the lesion&#39;s position in the coronary arterial system&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Blood samples were drawn via the antecubital vein at admission in patients undergoing elective coronary angiography following a fasting period of 12 h and collected in Becton Dickinson Vacutainer tubes containing 3&#46;6 mg of K2EDTA &#40;dipotassium ethylenediaminetetraacetic acid&#41; for hematological tests and in yellow top tubes without anticoagulant for biochemical tests&#46; Blood glucose&#44; creatinine&#44; hs-CRP&#44; and lipid profile were determined by standard methods&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> An automatic blood counter &#40;Sysmex XT-2000i Hematology Analyzer&#59; Sysmex&#44; Kobe&#44; Japan&#41; was used for whole blood counts&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">WBV was calculated from hematocrit &#40;HCT&#41; and plasma total protein &#40;TP&#41; at a low shear rate &#40;LSR&#59; 0&#46;5 s<span class="elsevierStyleSup">&#8211;1</span>&#41; and a high shear rate &#40;HSR&#59; 208 s<span class="elsevierStyleSup">&#8211;1</span>&#41; by the previously validated formula of de Simone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia><elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0075" class="elsevierStylePara elsevierViewall">Both WBV values were calculated taking into consideration Nwose and Richards&#8217; recommendation in the series on &#8216;Whole Blood Viscosity Assessment Issues&#8217; that extrapolation of WBV from HCT in &#37; and TP in g&#47;l is the most appropriate approach&#44; especially for estimating WBV in LSR&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using IBM SPSS software&#44; version 22 &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; The variables were investigated using visual &#40;histograms and probability plots&#41; and analytical methods &#40;Kolmogorov-Smirnov and Shapiro-Wilk tests&#41; to determine normality of distribution&#46; Continuous variables were presented as mean &#177; standard deviation or medians &#40;interquartile range&#41;&#44; and categorical variables were reported as number of patients and percentage&#46; The study population was divided into three groups&#58; control group&#44; MVA group&#44; and CAD group&#46; One-way analysis of variance was used to compare normally distributed laboratory variables&#46; Levene&#39;s test was used to assess the homogeneity of variances&#46; The Kruskal-Wallis test was used to compare non-normally distributed laboratory variables between groups&#46; The Mann-Whitney U test was performed to test the significance of pairwise differences using Bonferroni&#39;s correction to adjust for multiple comparisons&#46; To investigate the associations between non-normally distributed hs-CRP and WBV scores&#44; correlation coefficients and their significance were calculated using Spearman&#39;s correlation test&#46; The capacity of WBV to predict CAD and MVA at both LSR and HSR was analyzed using receiver operating characteristic &#40;ROC&#41; curve analysis&#46; When a significant cut-off value was observed&#44; the sensitivity&#44; specificity&#44; and positive and negative predictive values are presented&#46; For assessment of the area under the curve &#40;AUC&#41;&#44; a p-value &#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The three study groups were similar regarding gender distribution&#44; age&#44; and CAD risk factors including hypertension&#44; diabetes&#44; hyperlipidemia&#44; and smoking status&#46; The mean age of the study population was 52&#46;3&#177;6&#46;1 years &#40;range 49-67 years&#41;&#46; The baseline clinical parameters and laboratory findings of the study groups are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Hematological parameters including hemoglobin and mean platelet volume and biochemical parameters including fasting glucose&#44; urea&#44; serum creatinine&#44; serum albumin&#44; triglycerides&#44; and sodium and potassium levels were not statistically significant between the groups&#46; However&#44; hs-CRP&#44; red cell distribution width&#44; hematocrit&#44; white blood cell and platelet counts&#44; and total protein were significantly higher in both the MVA and CAD groups compared to the control group &#40;p&#60;0&#46;001&#41;&#46; In addition&#44; there were no significant differences between the MVA and CAD groups in these parameters&#46; Total cholesterol&#44; low-density lipoprotein &#40;LDL&#41; cholesterol&#44; and high-density lipoprotein cholesterol were found to be significantly higher in the MVA group compared to the control and CAD groups &#40;p&#60;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">CAD and MVA patients had significantly higher WBV at LSR &#40;72&#46;1&#177;27 and 62&#46;4&#177;18 vs&#46; 37&#46;4&#177;14&#59; p&#60;0&#46;001&#41; and HSR &#40;21&#177;4&#46;5 and 18&#46;3&#177;2&#46;8 vs&#46; 15&#46;1&#177;1&#46;6&#59; p&#60;0&#46;001&#41; compared with the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Correlation analysis revealed a significant relationship between hs-CRP and WBV at LSR &#40;r&#61;0&#46;556&#59; p&#60;0&#46;001&#41; and HSR &#40;r&#61;0&#46;562&#59; p&#60;0&#46;001&#41; in the CAD group and at LSR &#40;r&#61;0&#46;475&#59; p&#60;0&#46;001&#41; and HSR &#40;r&#61;0&#46;493&#59; p&#60;0&#46;001&#41; in the MVA group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Although mean WBV values showed a progressive elevation from controls to the CAD group&#44; there were statistically significant differences in WBV values between the CAD and MVA groups&#46; We therefore combined these groups to differentiate the microvascular and macrovascular effects of WBV from the control group for ROC analysis&#44; which revealed a WBV cut-off of &#8805;45 at LSR with sensitivity of 82&#37; and specificity of 78&#37; &#40;AUC 0&#46;861&#44; p&#60;0&#46;001&#41; and a cut-off of &#8805;16 at HSR with sensitivity of 83&#37; and specificity of 77&#37; &#40;AUC 0&#46;893&#44; p&#60;0&#46;001&#41; for prediction of CAD and MVA &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study set out to assess the importance of WBV at both LSR and HSR in the setting of CAD and MVA&#46; Our results revealed that WBV was markedly elevated in patients with CAD&#44; in line with previous studies in which WBV had been reported to be elevated in patients with both stable and unstable angina and acute coronary syndromes&#46; WBV has a significant independent relationship with the occurrence of adverse cardiovascular events&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8211;15</span></a> Furthermore&#44; in our study ROC curve analysis demonstrated that a WBV cut-off of &#8805;45 at LSR &#40;AUC 0&#46;861&#44; p&#60;0&#46;001&#41; and a cut-off of &#8805;16 at HSR &#40;AUC 0&#46;893&#44; p&#60;0&#46;001&#41; were predictive of CAD and MVA&#46; However&#44; some studies have questioned the effect of WBV in patients with nonobstructive CAD or MVA&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Although the causes of MVA&#44; particularly endothelial dysfunction&#44; are complex&#44; it is known to be linked to common cardiovascular risk factors such as smoking&#44; obesity&#44; hypercholesterolemia&#44; and inflammation&#46; However&#44; local factors&#44; such as hemodynamic forces including flow-generated endothelial shear stress and blood pressure-derived tensile stress&#44; are also known to play an important role&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Endothelial shear stress is defined as the frictional shear force of the flowing blood on the unit area of the arterial wall&#46; In normal physiologic shear stress&#44; endothelial cells produce endothelial NO synthase &#40;eNOS&#41; messenger ribonucleic acid &#40;mRNA&#41; and atheroprotective gene expression but decrease endothelin-1 &#40;ET-1&#41; mRNA&#46; On the other hand&#44; under low shear stress condition&#44; the response of endothelial cells is to increase the uptake of oxidized LDL cholesterol&#44; upregulating ICAM-1&#44; VCAM-1&#44; MCP-1&#44; E-selectin&#44; tumor necrosis factor-alpha &#40;TNF-&#945;&#41; and bone morphogenic protein-4&#44; but decreasing eNOS mRNA and protein expression&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> These responses lead to endothelial injury and dysfunction and inflammation&#46; Furthermore&#44; increased humoral &#40;C3a and C5a subunits of the complement system &#91;anaphylatoxins&#93;&#44; kinin&#44; and blood coagulation factors&#41; and cellular activation &#40;histamine&#44; serotonin&#44; granulocyte factors&#44; monokines&#44; lymphokines&#41; as a result of inflammation lead to an increase in blood viscosity&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> This study showed that WBV elevation may be an indicator of inflammation&#44; which is responsible for the endothelial dysfunction known to be the mechanism underlying the pathophysiology of macrovascular and microvascular coronary disease&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">C-reactive protein &#40;CRP&#41; is a well-known acute phase protein that is produced predominantly by hepatocytes in response to various cytokines such as interleukin &#40;IL&#41;-6 and TNF-&#945;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> It has been investigated in the context of arteriosclerosis and vascular diseases&#46; Based on multiple studies and guidelines&#44; elevation of hs-CRP has been shown to be associated with major cardiovascular risk &#40;hs-CRP &#60;1 mg&#47;l&#44; low risk&#59; 1-3 mg&#47;l&#44; intermediate risk&#59; 3-10 mg&#47;l&#44; high risk&#59; &#62;10 mg&#47;l&#44; nonspecific elevation&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#8211;23</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Lipid-lowering therapy is used to reduce levels of both LDL cholesterol and CRP&#44; and concurrently the number of CV events&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#8211;27</span></a> However&#44; it is unclear whether targeted inhibition of inflammation can reduce cardiovascular event rates&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recently&#44; the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study &#40;CANTOS&#41; demonstrated that direct inhibition of inflammation by the interleukin-1 beta inhibitor canakinumab could reduce the risk of future cardiovascular events&#44; while the Cardiovascular Inflammation Reduction Trial &#40;CIRT&#41; tested the inflammatory hypothesis of atherothrombosis by assessing whether low-dose methotrexate reduced rates of myocardial infarction&#44; stroke&#44; and cardiovascular death among stable CAD patients with type 2 diabetes or metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">As all these studies show the importance of inflammation at all stages of the atherothrombotic process&#44; it is persuasive that significant positive correlations were found between the inflammatory marker hs-CRP and WBV at both LSR and HSR in our study&#46; In particular&#44; pathophysiologically low shear stress has been found to have an association with increased expression of inflammatory genes&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> In view of these findings&#44; raised hs-CRP may be considered a reflection of increased inflammatory activity in the presence of elevated WBV&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our analysis has some limitations&#46; First&#44; this was a retrospective&#44; non-randomized&#44; single-center study&#46; Second&#44; microvascular dysfunction was not documented by endothelium-independent &#40;adenosine&#44; dypiramidole&#44; or papaverine challenge&#41; or endothelium-dependent &#40;acetylcholine challenge and cold pressor test&#41; testing of vasodilator activity&#46; Thirdly&#44; WBV was not validated by accurate measurement of viscosity using a viscometer&#46; As this study represents a pilot study for the use of WBV in assessment of the atherosclerotic process&#44; further studies with more patients are required to ascertain the value of this parameter and similar alternative indices&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">These results demonstrate that patients with CAD and with MVA had higher WBV at both LSR and HSR than the control group&#46; Furthermore&#44; hs-CRP was shown to have a positive correlation with WBV&#46; The key strength of this study is its demonstration of a significant and independent association between simple measurement of blood viscosity and the existence of endothelial inflammation and progression of the atherosclerotic process&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; or publication of this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Author contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">EC and BB contributed to the design of the work and drafted the manuscript&#46; All authors critically revised the manuscript&#46; All gave final approval and agreed to be accountable for all aspects of the work&#44; ensuring integrity and accuracy&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2018-12-19"
    "fechaAceptado" => "2019-04-07"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "C-reactive protein"
            1 => "Blood viscosity"
            2 => "Microvascular angina"
            3 => "Coronary artery disease"
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            0 => "Prote&#237;na C-reativa"
            1 => "Viscosidade sangu&#237;nea"
            2 => "Angina microvascular"
            3 => "Doen&#231;a arterial coron&#225;ria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole blood viscosity &#40;WBV&#41; is the intrinsic resistance of blood flow in vessels&#44; and when elevated induces endothelial shear stress and endothelial inflammation and can accelerate the atherosclerotic process&#46; This study aims to compare WBV levels in patients with microvascular angina &#40;MVA&#41;&#44; patients with coronary artery disease &#40;CAD&#41;&#44; and normal controls&#44; and to identify the relationship between WBV and high-sensitivity C-reactive protein as a marker of inflammation in MVA and CAD&#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 573 patients were studied&#46; The MVA group consisted of 189 subjects&#44; the CAD group consisted of 203 subjects&#44; and the control group consisted of 181 age- and gender-matched individuals&#46; WBV was calculated from hematocrit and plasma protein concentration at a low shear rate &#40;0&#46;5 s<span class="elsevierStyleSup">&#8211;1</span>&#41; and high shear rate &#40;208 s<span class="elsevierStyleSup">&#8211;1</span>&#41; by a validated equation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with CAD and MVA had significantly higher WBV at both low and high shear rates compared to the control group&#46; Correlation analysis revealed a significant relationship between high-sensitivity C-reactive protein and WBV at low &#40;r&#61;0&#46;556&#59; p&#60;0&#46;001&#41; and high shear rates &#40;r&#61;0&#46;562&#41; in the CAD group and at low &#40;r&#61;0&#46;475&#41; and high shear rates &#40;r&#61;0&#46;493&#41; in the MVA group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overall&#44; this study demonstrated a significant and independent association between blood viscosity and the existence of endothelial inflammation and the atherosclerotic process&#46;</p></span>"
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            "titulo" => "Introduction and Objectives"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A viscosidade sangu&#237;nea contribui para a resist&#234;ncia intr&#237;nseca do sangue nos vasos sangu&#237;neos&#44; induz <span class="elsevierStyleItalic">stress</span> de cisalhamento no endot&#233;lio&#44; inflama&#231;&#227;o no endot&#233;lio e processo ateroescler&#243;tico quando os valores s&#227;o elevados&#46; Este estudo tem o objetivo de comparar os n&#237;veis da viscosidade sangu&#237;nea nos doentes com angina microvascular&#44; com doen&#231;a arterial coron&#225;ria e na popula&#231;&#227;o normal e de identificar a rela&#231;&#227;o entre a viscosidade sangu&#237;nea e a prote&#237;na C reativa de alta sensibilidade como um marcador inflamat&#243;rio nos doentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram selecionados 573 doentes neste estudo&#46; O grupo da angina microvascular foi composto por 189 indiv&#237;duos&#44; o grupo da doen&#231;a arterial coron&#225;ria por 203 indiv&#237;duos e o grupo controlo por 181 indiv&#237;duos combinados por idade e g&#233;nero&#46; A viscosidade sangu&#237;nea foi calculada pelo hemat&#243;crito e pela concentra&#231;&#227;o da prote&#237;na plasm&#225;tica a uma taxa de cisalhamento baixa &#40;0&#44;5 s-1&#41; e a uma taxa de cisalhamento elevada &#40;208 s-1&#41; atrav&#233;s de equa&#231;&#227;o v&#225;lida&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os doentes com doen&#231;a arterial coron&#225;ria e com angina microvascular apresentaram viscosidade sangu&#237;nea mais elevada nas taxas de cisalhamento baixa e elevada quando comparados com o grupo controlo&#46; A correla&#231;&#227;o revelou uma rela&#231;&#227;o significativa entre a prote&#237;na C reativa de alta sensibilidade e a viscosidade sangu&#237;nea na taxa de cisalhamento baixa &#40;r &#61; 0&#44;556&#59; p &#60; 0&#44;001&#41; e na taxa de cisalhamento elevada &#40;r &#61; 0&#44;562&#41; no grupo da doen&#231;a arterial coron&#225;ria e na taxa de cisalhamento baixa &#40;r &#61; 0&#44;475&#41; e na taxa de cisalhamento elevada &#40;r &#61; 0&#44;493&#41; no grupo da angina microvascular&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Globalmente&#44; os aspetos principais deste estudo s&#227;o a demonstra&#231;&#227;o de uma associa&#231;&#227;o significativa e independente entre a viscosidade do sangue e a exist&#234;ncia de inflama&#231;&#227;o no endot&#233;lio e o processo ateroscler&#243;tico&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correlation between hs-CRP and HSR in the MVA group&#59; &#40;B&#41; correlation between hs-CRP and LSR in the MVA group&#59; &#40;C&#41; correlation between hs-CRP and HSR in the CAD group&#59; &#40;D&#41; correlation between hs-CRP and LSR in the CAD group&#46; CAD&#58; coronary artery disease&#59; hs-CRP&#58; high-sensitivity C-reactive protein&#59; HSR&#58; high shear rate&#59; LSR&#58; low shear rate&#59; MVA&#58; microvascular angina&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve &#40;ROC&#41; analysis of whole blood viscosity at high shear rate and low shear rate for the prediction of coronary artery disease and microvascular angina&#46; 95&#37; confidence intervals for ROC curve analysis are also displayed&#46; AUC&#58; area under the curve&#59; HSR&#58; high shear rate&#59; LSR&#58; low shear rate&#59; WBV&#58; whole blood viscosity&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CAD&#58; coronary artery disease&#59; HDL&#58; high-density lipoprotein&#59; hs-CRP&#58; high-sensitivity C-reactive protein&#59; LDL&#58; low-density lipoprotein&#59; MPV&#58; mean platelet volume&#59; MVA&#58; microvascular angina&#59; RDW&#58; red cell distribution width&#59; SYNTAX&#58; SYNergy between PCI with TAXUS and Cardiac Surgery&#59; TP&#58; total protein&#59; WBC&#58; white blood cell count&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Values are median &#40;IQR&#41;&#44; mean &#177; SD&#44; or n &#40;&#37;&#41;&#46;</p>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group &#40;n&#61;181&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MVA group &#40;n&#61;189&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAD group &#40;n&#61;203&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;7&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&#177;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;3&#177;6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;49&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105 &#40;52&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;43&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;43&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;26&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;34&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;33&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;34&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;38&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;38&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;41&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;2&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;3&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gensini score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;5&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SYNTAX score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hematocrit&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;9&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;3&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WBC&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#40;5&#46;2-7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#40;6&#46;9-10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#40;7&#46;1-10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MPV&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">9&#46;0 &#40;8&#46;3-10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;8 &#40;8&#46;2-9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;8 &#40;8&#46;0-10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RDW&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#46;7&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&#46;4&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#46;7&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Platelets&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">216 &#40;183-252&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">245 &#40;214-288&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">216 &#40;178-259&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood glucose&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&#177;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94&#177;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#46;4&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#177;5&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&#46;6&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum creatinine&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;8&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TP&#44; g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67&#46;2&#177;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#177;6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#46;4&#177;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum albumin&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;0&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;1&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&#177;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188&#177;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171&#177;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#177;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#177;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#177;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDL cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;35-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;40-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;35-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triglycerides&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">135 &#40;95-180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;100-192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;90-174&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>hs-CRP&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&#177;0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&#177;0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&#177;0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mEq&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original Article
Whole blood viscosity in microvascular angina and coronary artery disease: Significance and utility
Viscosidade sanguínea na angina microvascular e na doença arterial coronária: significado e viabilidade
Elif Ijlal Cekirdekci
Autor para correspondência
elifcekirdekci@hotmail.com

Corresponding author.
, Baris Bugan
University of Kyrenia, Department of Cardiology, Kyrenia, Mersin, Turkey
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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">Atherosclerosis is a prevalent cardiovascular disease characterized by inflammation and plaque formation within arterial walls&#46; By means of coronary angiography&#44; it is possible to visualize the contours of the epicardial coronary arterial tree in vivo&#46; However&#44; abnormalities in the function and structure of coronary microcirculation deserve additional attention&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Vascular endothelial cells are exposed to hemodynamic forces &#40;including hydrostatic pressure&#44; cyclic stretch&#44; and fluid shear stress&#41;&#44; which modulate the functions of these cells in health and disease&#46; Flow patterns and hemodynamic forces in the vascular system are not uniform&#46; In straight parts of the arterial tree&#44; high shear stress upregulates genes that are protective against atherosclerosis under sustained laminar blood flow&#59; however&#44; in branches and curvatures the nonuniform and irregular blood distribution of low shear stress induces genes that promote endothelial abnormalities and atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Whole blood viscosity &#40;WBV&#41; is the intrinsic resistance of blood flow in vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Factors including hematocrit&#44; total plasma protein&#44; erythrocyte aggregation&#44; and erythrocyte deformability may influence WBV&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Studies have shown that elevated WBV may promote endothelial shear stress&#44; endothelial inflammation&#44; and vascular remodeling&#44; and can accelerate the atherosclerotic process&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study is twofold&#46; The first is to compare WBV levels in patients with microvascular angina &#40;MVA&#41;&#44; patients with coronary artery disease &#40;CAD&#41;&#44; and normal controls&#46; The second is to identify the relationship between WBV and high-sensitivity C-reactive protein &#40;hs-CRP&#41; as a marker of inflammation in CAD and MVA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 3160 patients undergoing diagnostic coronary angiography between February 2016 and December 2017 were analyzed retrospectively&#46; Of these&#44; 573 patients for whom hs-CRP and WBV parameters were available were selected for the current study&#46; The MVA group consisted of 189 subjects &#40;93 men&#44; mean age 58&#46;1&#177;8&#46;7 years&#41; with anginal chest pain but a normal coronary angiogram&#44; the CAD group consisted of 203 subjects &#40;105 men&#44; mean age 59&#46;3&#177;6&#46;9 years&#41;&#44; and the control group included 181 age- and gender-matched individuals &#40;96 men&#44; mean age 59&#46;7&#177;7&#46;2 years&#41; without known cardiac disease or signs of inducible ischemia on myocardial perfusion scintigraphy or treadmill exercise test&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with valvular heart disease&#44; heart failure&#44; cardiomyopathy&#44; hematological disease &#40;including anemia&#41;&#44; cancer&#44; active or chronic infectious or inflammatory disease&#44; autoimmune disease&#44; or other neurological or musculoskeletal disorders were excluded&#46; Informed consent was obtained from all patients before noninvasive and invasive protocols&#46; The study was approved by the local ethics committee&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All subjects underwent a detailed medical history&#44; physical examination&#44; and biochemical and hematological tests&#46; After the physical examination patients underwent treadmill exercise testing and myocardial perfusion testing&#46; If these tests revealed myocardial ischemia&#44; the patients were enrolled for coronary angiography&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients performed a typical Bruce or modified Bruce protocol test in accordance with recent guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Symptoms&#44; baseline and peak heart rate&#44; age-predicted maximum heart rate &#40;APMHR&#41;&#44; baseline and maximum blood pressure&#44; rhythm abnormalities&#44; and maximum ST deviation were assessed and the Duke treadmill score was calculated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Endpoints for termination of the exercise test were clinically significant ST-segment changes &#40;&#62;2 mm depression in two contiguous leads measured 80 ms after the J point&#41;&#44; worsening angina&#44; clinically significant arrhythmias&#44; drop in systolic blood pressure with increasing workload&#44; signs of poor perfusion&#44; or achievement of the APMHR without such disturbances&#46; In patients with a borderline or nondiagnostic treadmill exercise test&#44; stress perfusion imaging with single-photon emission computed tomography was performed with a single-head gamma camera equipped with a general purpose&#44; low-energy high-resolution parallel hole collimator &#40;Orbiter 400&#44; Siemens AG&#41;&#44; using either TL-201 or Tc-99m in accordance with the relevant guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Patients with pathologic treadmill exercise or myocardial perfusion tests were referred for coronary angiography&#44; which was performed using the Judkins method&#44; with a femoral artery approach&#46; Patients in whom coronary angiography revealed no visible disease or luminal irregularities &#40;less than 50&#37;&#41;&#44; according to a consensual decision between three experienced cardiologists&#44; were included in the MVA group&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">MVA was diagnosed on the basis of typical effort-induced angina-like discomfort associated with either transient ischemic ST-segment depression &#40;&#8805;1 mm&#41; during the treadmill exercise test &#40;93 patients&#41; or reversible perfusion defects on myocardial perfusion scintigraphy &#40;96 patients&#41; with angiographically normal coronary arteries and without coronary artery spasm&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the CAD group&#44; coronary lesions with &#8805;50&#37; stenosis in vessels of diameter &#8805;1&#46;5 mm were considered&#46; The Gensini and SYNergy between PCI with TAXUS and Cardiac Surgery &#40;SYNTAX&#41; scores were used to determine the extent and severity of CAD&#46; The online calculator was used for the SYNTAX scores &#40;<a href="http://www.syntaxscore.com/">www&#46;syntaxscore&#46;com</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The Gensini score grades stenosis in the epicardial coronary arteries as 1 for 1-25&#37; stenosis&#44; 2 for 26-50&#37;&#44; 4 for 51-75&#37;&#44; 8 for 76-90&#37;&#44; 16 for 91-99&#37;&#44; and 32 for total occlusion&#46; This score is then multiplied by a factor from 0&#46;5 to 5 taking into account the importance of the lesion&#39;s position in the coronary arterial system&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Blood samples were drawn via the antecubital vein at admission in patients undergoing elective coronary angiography following a fasting period of 12 h and collected in Becton Dickinson Vacutainer tubes containing 3&#46;6 mg of K2EDTA &#40;dipotassium ethylenediaminetetraacetic acid&#41; for hematological tests and in yellow top tubes without anticoagulant for biochemical tests&#46; Blood glucose&#44; creatinine&#44; hs-CRP&#44; and lipid profile were determined by standard methods&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> An automatic blood counter &#40;Sysmex XT-2000i Hematology Analyzer&#59; Sysmex&#44; Kobe&#44; Japan&#41; was used for whole blood counts&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">WBV was calculated from hematocrit &#40;HCT&#41; and plasma total protein &#40;TP&#41; at a low shear rate &#40;LSR&#59; 0&#46;5 s<span class="elsevierStyleSup">&#8211;1</span>&#41; and a high shear rate &#40;HSR&#59; 208 s<span class="elsevierStyleSup">&#8211;1</span>&#41; by the previously validated formula of de Simone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia><elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0075" class="elsevierStylePara elsevierViewall">Both WBV values were calculated taking into consideration Nwose and Richards&#8217; recommendation in the series on &#8216;Whole Blood Viscosity Assessment Issues&#8217; that extrapolation of WBV from HCT in &#37; and TP in g&#47;l is the most appropriate approach&#44; especially for estimating WBV in LSR&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using IBM SPSS software&#44; version 22 &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; The variables were investigated using visual &#40;histograms and probability plots&#41; and analytical methods &#40;Kolmogorov-Smirnov and Shapiro-Wilk tests&#41; to determine normality of distribution&#46; Continuous variables were presented as mean &#177; standard deviation or medians &#40;interquartile range&#41;&#44; and categorical variables were reported as number of patients and percentage&#46; The study population was divided into three groups&#58; control group&#44; MVA group&#44; and CAD group&#46; One-way analysis of variance was used to compare normally distributed laboratory variables&#46; Levene&#39;s test was used to assess the homogeneity of variances&#46; The Kruskal-Wallis test was used to compare non-normally distributed laboratory variables between groups&#46; The Mann-Whitney U test was performed to test the significance of pairwise differences using Bonferroni&#39;s correction to adjust for multiple comparisons&#46; To investigate the associations between non-normally distributed hs-CRP and WBV scores&#44; correlation coefficients and their significance were calculated using Spearman&#39;s correlation test&#46; The capacity of WBV to predict CAD and MVA at both LSR and HSR was analyzed using receiver operating characteristic &#40;ROC&#41; curve analysis&#46; When a significant cut-off value was observed&#44; the sensitivity&#44; specificity&#44; and positive and negative predictive values are presented&#46; For assessment of the area under the curve &#40;AUC&#41;&#44; a p-value &#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The three study groups were similar regarding gender distribution&#44; age&#44; and CAD risk factors including hypertension&#44; diabetes&#44; hyperlipidemia&#44; and smoking status&#46; The mean age of the study population was 52&#46;3&#177;6&#46;1 years &#40;range 49-67 years&#41;&#46; The baseline clinical parameters and laboratory findings of the study groups are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Hematological parameters including hemoglobin and mean platelet volume and biochemical parameters including fasting glucose&#44; urea&#44; serum creatinine&#44; serum albumin&#44; triglycerides&#44; and sodium and potassium levels were not statistically significant between the groups&#46; However&#44; hs-CRP&#44; red cell distribution width&#44; hematocrit&#44; white blood cell and platelet counts&#44; and total protein were significantly higher in both the MVA and CAD groups compared to the control group &#40;p&#60;0&#46;001&#41;&#46; In addition&#44; there were no significant differences between the MVA and CAD groups in these parameters&#46; Total cholesterol&#44; low-density lipoprotein &#40;LDL&#41; cholesterol&#44; and high-density lipoprotein cholesterol were found to be significantly higher in the MVA group compared to the control and CAD groups &#40;p&#60;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">CAD and MVA patients had significantly higher WBV at LSR &#40;72&#46;1&#177;27 and 62&#46;4&#177;18 vs&#46; 37&#46;4&#177;14&#59; p&#60;0&#46;001&#41; and HSR &#40;21&#177;4&#46;5 and 18&#46;3&#177;2&#46;8 vs&#46; 15&#46;1&#177;1&#46;6&#59; p&#60;0&#46;001&#41; compared with the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Correlation analysis revealed a significant relationship between hs-CRP and WBV at LSR &#40;r&#61;0&#46;556&#59; p&#60;0&#46;001&#41; and HSR &#40;r&#61;0&#46;562&#59; p&#60;0&#46;001&#41; in the CAD group and at LSR &#40;r&#61;0&#46;475&#59; p&#60;0&#46;001&#41; and HSR &#40;r&#61;0&#46;493&#59; p&#60;0&#46;001&#41; in the MVA group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Although mean WBV values showed a progressive elevation from controls to the CAD group&#44; there were statistically significant differences in WBV values between the CAD and MVA groups&#46; We therefore combined these groups to differentiate the microvascular and macrovascular effects of WBV from the control group for ROC analysis&#44; which revealed a WBV cut-off of &#8805;45 at LSR with sensitivity of 82&#37; and specificity of 78&#37; &#40;AUC 0&#46;861&#44; p&#60;0&#46;001&#41; and a cut-off of &#8805;16 at HSR with sensitivity of 83&#37; and specificity of 77&#37; &#40;AUC 0&#46;893&#44; p&#60;0&#46;001&#41; for prediction of CAD and MVA &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study set out to assess the importance of WBV at both LSR and HSR in the setting of CAD and MVA&#46; Our results revealed that WBV was markedly elevated in patients with CAD&#44; in line with previous studies in which WBV had been reported to be elevated in patients with both stable and unstable angina and acute coronary syndromes&#46; WBV has a significant independent relationship with the occurrence of adverse cardiovascular events&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8211;15</span></a> Furthermore&#44; in our study ROC curve analysis demonstrated that a WBV cut-off of &#8805;45 at LSR &#40;AUC 0&#46;861&#44; p&#60;0&#46;001&#41; and a cut-off of &#8805;16 at HSR &#40;AUC 0&#46;893&#44; p&#60;0&#46;001&#41; were predictive of CAD and MVA&#46; However&#44; some studies have questioned the effect of WBV in patients with nonobstructive CAD or MVA&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Although the causes of MVA&#44; particularly endothelial dysfunction&#44; are complex&#44; it is known to be linked to common cardiovascular risk factors such as smoking&#44; obesity&#44; hypercholesterolemia&#44; and inflammation&#46; However&#44; local factors&#44; such as hemodynamic forces including flow-generated endothelial shear stress and blood pressure-derived tensile stress&#44; are also known to play an important role&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Endothelial shear stress is defined as the frictional shear force of the flowing blood on the unit area of the arterial wall&#46; In normal physiologic shear stress&#44; endothelial cells produce endothelial NO synthase &#40;eNOS&#41; messenger ribonucleic acid &#40;mRNA&#41; and atheroprotective gene expression but decrease endothelin-1 &#40;ET-1&#41; mRNA&#46; On the other hand&#44; under low shear stress condition&#44; the response of endothelial cells is to increase the uptake of oxidized LDL cholesterol&#44; upregulating ICAM-1&#44; VCAM-1&#44; MCP-1&#44; E-selectin&#44; tumor necrosis factor-alpha &#40;TNF-&#945;&#41; and bone morphogenic protein-4&#44; but decreasing eNOS mRNA and protein expression&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> These responses lead to endothelial injury and dysfunction and inflammation&#46; Furthermore&#44; increased humoral &#40;C3a and C5a subunits of the complement system &#91;anaphylatoxins&#93;&#44; kinin&#44; and blood coagulation factors&#41; and cellular activation &#40;histamine&#44; serotonin&#44; granulocyte factors&#44; monokines&#44; lymphokines&#41; as a result of inflammation lead to an increase in blood viscosity&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> This study showed that WBV elevation may be an indicator of inflammation&#44; which is responsible for the endothelial dysfunction known to be the mechanism underlying the pathophysiology of macrovascular and microvascular coronary disease&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">C-reactive protein &#40;CRP&#41; is a well-known acute phase protein that is produced predominantly by hepatocytes in response to various cytokines such as interleukin &#40;IL&#41;-6 and TNF-&#945;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> It has been investigated in the context of arteriosclerosis and vascular diseases&#46; Based on multiple studies and guidelines&#44; elevation of hs-CRP has been shown to be associated with major cardiovascular risk &#40;hs-CRP &#60;1 mg&#47;l&#44; low risk&#59; 1-3 mg&#47;l&#44; intermediate risk&#59; 3-10 mg&#47;l&#44; high risk&#59; &#62;10 mg&#47;l&#44; nonspecific elevation&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#8211;23</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Lipid-lowering therapy is used to reduce levels of both LDL cholesterol and CRP&#44; and concurrently the number of CV events&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#8211;27</span></a> However&#44; it is unclear whether targeted inhibition of inflammation can reduce cardiovascular event rates&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recently&#44; the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study &#40;CANTOS&#41; demonstrated that direct inhibition of inflammation by the interleukin-1 beta inhibitor canakinumab could reduce the risk of future cardiovascular events&#44; while the Cardiovascular Inflammation Reduction Trial &#40;CIRT&#41; tested the inflammatory hypothesis of atherothrombosis by assessing whether low-dose methotrexate reduced rates of myocardial infarction&#44; stroke&#44; and cardiovascular death among stable CAD patients with type 2 diabetes or metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">As all these studies show the importance of inflammation at all stages of the atherothrombotic process&#44; it is persuasive that significant positive correlations were found between the inflammatory marker hs-CRP and WBV at both LSR and HSR in our study&#46; In particular&#44; pathophysiologically low shear stress has been found to have an association with increased expression of inflammatory genes&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> In view of these findings&#44; raised hs-CRP may be considered a reflection of increased inflammatory activity in the presence of elevated WBV&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our analysis has some limitations&#46; First&#44; this was a retrospective&#44; non-randomized&#44; single-center study&#46; Second&#44; microvascular dysfunction was not documented by endothelium-independent &#40;adenosine&#44; dypiramidole&#44; or papaverine challenge&#41; or endothelium-dependent &#40;acetylcholine challenge and cold pressor test&#41; testing of vasodilator activity&#46; Thirdly&#44; WBV was not validated by accurate measurement of viscosity using a viscometer&#46; As this study represents a pilot study for the use of WBV in assessment of the atherosclerotic process&#44; further studies with more patients are required to ascertain the value of this parameter and similar alternative indices&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">These results demonstrate that patients with CAD and with MVA had higher WBV at both LSR and HSR than the control group&#46; Furthermore&#44; hs-CRP was shown to have a positive correlation with WBV&#46; The key strength of this study is its demonstration of a significant and independent association between simple measurement of blood viscosity and the existence of endothelial inflammation and progression of the atherosclerotic process&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; or publication of this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Author contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">EC and BB contributed to the design of the work and drafted the manuscript&#46; All authors critically revised the manuscript&#46; All gave final approval and agreed to be accountable for all aspects of the work&#44; ensuring integrity and accuracy&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2018-12-19"
    "fechaAceptado" => "2019-04-07"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "C-reactive protein"
            1 => "Blood viscosity"
            2 => "Microvascular angina"
            3 => "Coronary artery disease"
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            0 => "Prote&#237;na C-reativa"
            1 => "Viscosidade sangu&#237;nea"
            2 => "Angina microvascular"
            3 => "Doen&#231;a arterial coron&#225;ria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole blood viscosity &#40;WBV&#41; is the intrinsic resistance of blood flow in vessels&#44; and when elevated induces endothelial shear stress and endothelial inflammation and can accelerate the atherosclerotic process&#46; This study aims to compare WBV levels in patients with microvascular angina &#40;MVA&#41;&#44; patients with coronary artery disease &#40;CAD&#41;&#44; and normal controls&#44; and to identify the relationship between WBV and high-sensitivity C-reactive protein as a marker of inflammation in MVA and CAD&#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 573 patients were studied&#46; The MVA group consisted of 189 subjects&#44; the CAD group consisted of 203 subjects&#44; and the control group consisted of 181 age- and gender-matched individuals&#46; WBV was calculated from hematocrit and plasma protein concentration at a low shear rate &#40;0&#46;5 s<span class="elsevierStyleSup">&#8211;1</span>&#41; and high shear rate &#40;208 s<span class="elsevierStyleSup">&#8211;1</span>&#41; by a validated equation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with CAD and MVA had significantly higher WBV at both low and high shear rates compared to the control group&#46; Correlation analysis revealed a significant relationship between high-sensitivity C-reactive protein and WBV at low &#40;r&#61;0&#46;556&#59; p&#60;0&#46;001&#41; and high shear rates &#40;r&#61;0&#46;562&#41; in the CAD group and at low &#40;r&#61;0&#46;475&#41; and high shear rates &#40;r&#61;0&#46;493&#41; in the MVA group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overall&#44; this study demonstrated a significant and independent association between blood viscosity and the existence of endothelial inflammation and the atherosclerotic process&#46;</p></span>"
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            "titulo" => "Introduction and Objectives"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A viscosidade sangu&#237;nea contribui para a resist&#234;ncia intr&#237;nseca do sangue nos vasos sangu&#237;neos&#44; induz <span class="elsevierStyleItalic">stress</span> de cisalhamento no endot&#233;lio&#44; inflama&#231;&#227;o no endot&#233;lio e processo ateroescler&#243;tico quando os valores s&#227;o elevados&#46; Este estudo tem o objetivo de comparar os n&#237;veis da viscosidade sangu&#237;nea nos doentes com angina microvascular&#44; com doen&#231;a arterial coron&#225;ria e na popula&#231;&#227;o normal e de identificar a rela&#231;&#227;o entre a viscosidade sangu&#237;nea e a prote&#237;na C reativa de alta sensibilidade como um marcador inflamat&#243;rio nos doentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram selecionados 573 doentes neste estudo&#46; O grupo da angina microvascular foi composto por 189 indiv&#237;duos&#44; o grupo da doen&#231;a arterial coron&#225;ria por 203 indiv&#237;duos e o grupo controlo por 181 indiv&#237;duos combinados por idade e g&#233;nero&#46; A viscosidade sangu&#237;nea foi calculada pelo hemat&#243;crito e pela concentra&#231;&#227;o da prote&#237;na plasm&#225;tica a uma taxa de cisalhamento baixa &#40;0&#44;5 s-1&#41; e a uma taxa de cisalhamento elevada &#40;208 s-1&#41; atrav&#233;s de equa&#231;&#227;o v&#225;lida&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os doentes com doen&#231;a arterial coron&#225;ria e com angina microvascular apresentaram viscosidade sangu&#237;nea mais elevada nas taxas de cisalhamento baixa e elevada quando comparados com o grupo controlo&#46; A correla&#231;&#227;o revelou uma rela&#231;&#227;o significativa entre a prote&#237;na C reativa de alta sensibilidade e a viscosidade sangu&#237;nea na taxa de cisalhamento baixa &#40;r &#61; 0&#44;556&#59; p &#60; 0&#44;001&#41; e na taxa de cisalhamento elevada &#40;r &#61; 0&#44;562&#41; no grupo da doen&#231;a arterial coron&#225;ria e na taxa de cisalhamento baixa &#40;r &#61; 0&#44;475&#41; e na taxa de cisalhamento elevada &#40;r &#61; 0&#44;493&#41; no grupo da angina microvascular&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Globalmente&#44; os aspetos principais deste estudo s&#227;o a demonstra&#231;&#227;o de uma associa&#231;&#227;o significativa e independente entre a viscosidade do sangue e a exist&#234;ncia de inflama&#231;&#227;o no endot&#233;lio e o processo ateroscler&#243;tico&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correlation between hs-CRP and HSR in the MVA group&#59; &#40;B&#41; correlation between hs-CRP and LSR in the MVA group&#59; &#40;C&#41; correlation between hs-CRP and HSR in the CAD group&#59; &#40;D&#41; correlation between hs-CRP and LSR in the CAD group&#46; CAD&#58; coronary artery disease&#59; hs-CRP&#58; high-sensitivity C-reactive protein&#59; HSR&#58; high shear rate&#59; LSR&#58; low shear rate&#59; MVA&#58; microvascular angina&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve &#40;ROC&#41; analysis of whole blood viscosity at high shear rate and low shear rate for the prediction of coronary artery disease and microvascular angina&#46; 95&#37; confidence intervals for ROC curve analysis are also displayed&#46; AUC&#58; area under the curve&#59; HSR&#58; high shear rate&#59; LSR&#58; low shear rate&#59; WBV&#58; whole blood viscosity&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CAD&#58; coronary artery disease&#59; HDL&#58; high-density lipoprotein&#59; hs-CRP&#58; high-sensitivity C-reactive protein&#59; LDL&#58; low-density lipoprotein&#59; MPV&#58; mean platelet volume&#59; MVA&#58; microvascular angina&#59; RDW&#58; red cell distribution width&#59; SYNTAX&#58; SYNergy between PCI with TAXUS and Cardiac Surgery&#59; TP&#58; total protein&#59; WBC&#58; white blood cell count&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Values are median &#40;IQR&#41;&#44; mean &#177; SD&#44; or n &#40;&#37;&#41;&#46;</p>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group &#40;n&#61;181&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MVA group &#40;n&#61;189&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAD group &#40;n&#61;203&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;7&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&#177;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;3&#177;6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;49&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105 &#40;52&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;43&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;43&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;26&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;34&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;33&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;34&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;38&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;38&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;41&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;2&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;3&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gensini score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;5&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SYNTAX score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hematocrit&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;9&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;3&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WBC&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#40;5&#46;2-7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#40;6&#46;9-10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#40;7&#46;1-10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MPV&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">9&#46;0 &#40;8&#46;3-10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;8 &#40;8&#46;2-9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;8 &#40;8&#46;0-10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RDW&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#46;7&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&#46;4&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#46;7&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Platelets&#44; 10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">216 &#40;183-252&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">245 &#40;214-288&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">216 &#40;178-259&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood glucose&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&#177;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#177;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94&#177;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#46;4&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#177;5&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&#46;6&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum creatinine&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;8&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TP&#44; g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67&#46;2&#177;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#177;6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#46;4&#177;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum albumin&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;0&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;1&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&#177;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188&#177;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171&#177;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#177;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#177;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#177;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDL cholesterol&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;35-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;40-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;35-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triglycerides&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">135 &#40;95-180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;100-192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;90-174&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>hs-CRP&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&#177;0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&#177;0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&#177;0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mEq&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Revista Portuguesa de Cardiologia
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