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CLINICAL SCIENCE
The effects of iron deficiency anemia on p wave duration and dispersion
Hakkı SimsekI,
Corresponding author
dr.hsimsek@hotmail.com

Tel.: 905052178039
, Yilmaz GunesI, Cengiz DemirII, Musa SahinI, Hasan Ali GumrukcuogluI, Mustafa TuncerI
I Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey
II Yuzuncu Yil University, Faculty of Medicine, Hematology Department, Van, Turkey
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Correlation between hemoglobin level and P wave dispersion&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">P wave dispersion &#40;PWD&#41; is defined as the difference between the longest and the shortest P-wave duration recorded from multiple different surface ECG leads&#46; To date&#44; the most extensive clinical evaluation of PWD has been performed in the assessment of the risk for atrial fibrillation &#40;AF&#41;&#44; which is characterized by inhomogeneous and discontinuous atrial conduction&#46; Several studies have showed that PWD has a predictive value for the development of AF in patients without apparent heart disease and in patients who were hypertensive or had various cardiac conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1-3</a> Apart from cardiovascular diseases&#44; several conditions such as seasonal variation&#44; alcohol intake and caffeine ingestion have been demonstrated to affect PWD&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4-6</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Anemia is an independent risk factor for adverse cardiovascular outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;8</a> The iron status of an individual may play an important role in cardiovascular health because either an excess of iron or iron deficiency can lead to significant problems&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a> Increased risks of left ventricular &#40;LV&#41; dilatation&#44; systolic dysfunction&#44; chronic heart failure and death have been shown to be associated with a decrease in hemoglobin &#40;Hb&#41; concentration of as little as 1 g&#47;dL&#46;<a class="elsevierStyleCrossRefs" href="#bib10">10&#44;11</a></p><p id="para30" class="elsevierStylePara elsevierViewall">To our knowledge&#44; the association between PWD and iron deficiency anemia &#40;IDA&#41; has not been documented in the literature&#46; In this study&#44; we evaluated PWD in patients with IDA and the possible relationships between PWD and other echocardiographic parameters&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">MATERIALS AND METHODS</span><p id="para40" class="elsevierStylePara elsevierViewall">In this study&#44; 97 patients with IDA and 50 healthy controls were included&#44; and the following laboratory tests were conducted&#58; complete blood count&#44; peripheral smear&#44; serum ferritin&#44; vitamin B12&#44; folate&#44; serum iron&#44; iron binding capacity and transferrin saturations&#46; The diagnosis of iron deficiency anemia was established as follows&#58; hemoglobin &#60;12 g&#47;dL in women and &#60;13 g&#47;dL in men&#59; serum ferritin &#60;12 ng&#47;mL&#59; and mean corpuscular volume &#40;MCV&#41; and mean corpuscular hemoglobin concentration &#40;MCHC&#41; values below the normal range &#40;i&#46;e&#46;&#44; 83-97 fL and 32-36 g&#47;dL&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a></p><p id="para50" class="elsevierStylePara elsevierViewall">All study cases were evaluated with a detailed clinical examination and diagnostic testing that included 12-lead electrocardiography and transthoracic echocardiography&#46; Patients with the following conditions were excluded&#58; acute bleeding&#44; chronic bleeding resulting from malignancy&#44; vitamin B12 or folate deficiency&#44; thalassemia&#44; sickle cell disease&#44; structural heart disease&#44; ischemic heart disease&#44; diabetes&#44; hypertension&#44; renal failure&#44; chronic obstructive pulmonary disease&#44; hypo- or hyperthyroidism and any other systemic diseases&#46; The subjects from the control group were comparable to patients with iron deficiency anemia in age&#44; sex and body mass index&#44; were free from any cardiovascular disorder and were not taking any cardioactive drugs&#46; All subjects gave written informed consent to the study&#44; and the study was approved by the hospital ethics committee in accordance with the Declaration of Helsinki&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">Using a commercially available machine &#40;Marquette Case&#44; Hellige Medical System&#44; Cardiosmart&#44; Hellige Instrument Company&#44; Freiburg&#44; Germany&#41; and with the patient in a supine position&#44; 12-lead ECGs with 20 mm&#47;mV amplitude&#44; 50 mm&#47;sec rate and standard lead positions were obtained after a 10-minute rest period&#46; Using a magnifying glass&#44; P wave durations were manually measured by two cardiologists who had no information about the patients&#46; The beginning of the P wave was defined as the point at which the initial deflection of the P wave crossed the isoelectric line&#44; and the end of the P wave was defined as the point at which the final deflection of the P wave crossed the isoelectric line&#46; The difference between maximum and minimum P wave duration &#40;Pmax and Pmin&#44; respectively&#41; was defined as PWD&#46; Intra- and inter-observer coefficients of the variation for P wave variables were insignificant at less than 5&#37;&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">Using a commercially available echocardiographic device &#40;Vivid 3&#44; General Electric&#41; with a 3-MHz transducer&#44; the echocardiographic examination was performed with the patient at rest in a left lateral decubitis position&#46; Two experienced echocardiographers&#44; who were blinded to the clinical data&#44; conducted the examination&#46; Using M-mode echocardiography&#44; long-axis measurements were obtained at the level distal to the mitral valve leaflets according to current recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> Left ventricular ejection fraction &#40;LVEF&#41; was calculated via the modified biplane Simpson&#39;s method from apical four- and two-chamber views&#46; The pulsed Doppler sampling volume was placed between the tips of the mitral valve leaflets to obtain maximum filling velocities&#46; Early diastolic flow &#40;E&#41;&#44; atrial contraction signal &#40;A&#41; and E deceleration time &#40;DT&#41; were measured&#46; Isovolumetric relaxation time &#40;IVRT&#41; was determined as the interval between the end of the aortic outflow and the start of the mitral inflow signal&#46; Using the pulsed wave spectral mode&#44; Tissue Doppler Imaging &#40;TDI&#41; was acquired to assess diastolic function&#46; Filters and baselines were corrected when the velocity ranged between -20 and &#43;20 cm&#47;s&#46; From the apical four-chamber view&#44; a 5-mm sample volume was placed at the lateral corner of the mitral annulus&#46; Early &#40;Em&#41; and late &#40;Am&#41; diastolic velocities as well as the Em&#47;Am ratio were calculated&#46; All values were measured on three separate beats and then averaged for all parameters&#46; During the entire echocardiographic study&#44; a single-lead electrocardiogram was continuously recorded&#46; Intra- and inter-observer coefficients of variation for echocardiographic measurements were insignificant at less than 10&#37;&#46; Impaired left ventricular relaxation was defined as an Em&#47;Am ratio &#60;1 and Ea &#60;10 cm&#47;sec and&#47;or all three of the following&#58; an E&#47;A ratio &#60;1 &#40;or &#60; 0&#46;5 for patients who were &#62;50 years old&#41;&#44; DT &#62; 200 msec and IVRT &#62; 100 msec &#40;or &#62;105 msec for patients who were &#62;50 years old&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib14">14&#44;15</a></p><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Statistics</span><p id="para80" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as the mean &#177; standard deviation &#40;SD&#41;&#44; and qualitative variables are expressed as numbers and percentages&#46; Differences between independent groups were assessed by t-tests for quantitative data&#44; the Chi-squared test for qualitative variables and the Mann-Whitney&#39;s U-test for variables without a normal distribution&#46; Using Pearson correlation analysis&#44; the relationship between P wave variables and clinical and echocardiographic variables were assessed&#46; All tests were performed using the SPSS program for Windows&#44; version 10&#46;0&#46; A two-tailed p value of &#60;0&#46;05 was considered significant&#46;</p></span></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">RESULTS</span><p id="para90" class="elsevierStylePara elsevierViewall">Baseline characteristics were not significantly different between IDA patients and control subjects&#46; Hemoglobin levels among patients with IDA ranged between 4&#46;7 and 10&#46;0 g&#47;dL&#46; The etiologies for iron deficiency were as follows&#58; menorrhagia in 12 cases&#44; ulcerated hiatus hernia in 13 cases&#44; peptic ulcer in 21 cases&#44; hookworm infection in 4 cases&#44; hemorrhoidal bleeding in 15 cases&#44; inflammatory bowel disease in 3 cases&#44; esophagitis in 8 cases&#44; atrophic gastritis in 4 cases&#44; diverticulosis in 5 cases&#44; stomach surgery in 6 cases and chronic blood donors in 6 cases&#46; Mean heart rate&#44; DT and IVRT were significantly increased&#44; and diastolic dysfunction was significantly more frequent among IDA patients &#40;<a class="elsevierStyleCrossRef" href="#t1-cln_65p1067">Table 1</a>&#41;&#46; Maximum P wave duration and PWD were significantly longer in patients with IDA &#40;<a class="elsevierStyleCrossRef" href="#t2-cln_65p1067">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="t1-cln_65p1067"></elsevierMultimedia><elsevierMultimedia ident="t2-cln_65p1067"></elsevierMultimedia><p id="para100" class="elsevierStylePara elsevierViewall">PWD was significantly correlated with the following&#58; presence of anemia &#40;r &#61; 0&#46;474&#44; p&#60;0&#46;001&#41;&#44; Hb level &#40;r &#61; -0&#46;451&#44; p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig1-cln_65p1067">Figure 1</a>&#41;&#44; IVRT &#40;r &#61; 0&#46;347&#44; p&#60;0&#46;001&#41;&#44; DT &#40;r &#61; 0&#46;255&#44; p &#61; 0&#46;011&#41; and heart rate &#40;r &#61; 0&#46;252&#44; p &#61; 0&#46;011&#41;&#46; PWD was not significantly correlated with any other clinical or echocardiographic parameters&#44; including age&#44; gender&#44; LVEF and systolic and diastolic blood pressure&#46;</p><elsevierMultimedia ident="fig1-cln_65p1067"></elsevierMultimedia></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">DISCUSSION</span><p id="para110" class="elsevierStylePara elsevierViewall">In this study&#44; we found that P max and PWD were significantly prolonged in patients with iron deficiency anemia&#46; In addition&#44; the frequency of left ventricular diastolic dysfunction was increased in IDA&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">Se-veral studies have shown that PWD has a predictive value for AF in patients with no underlying heart disease and in those who are hypertensive and have various other cardiac conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1-3</a> PWD is a simple electrocardiographic marker that could be used for the prediction of paroxysmal AF&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;16</a> Several factors have been shown to influence PWD&#46; A seasonal variation has been demonstrated in healthy subjects&#59; specifically&#44; PWD is shortest in the summer and longest in the winter&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> Furthermore&#44; the effects of obesity&#44; acute caffeine ingestion&#44; alcohol intake and high altitude on PWD in healthy subjects have been evaluated in several studies&#44; and differences between trained athletes and control subjects have also been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib5">5&#44;6&#44;18-20</a> Therefore&#44; it might be inappropriate to use a single PWD measurement as a predictor of AF in healthy people because PWD is influenced by many parameters&#44; which may be risk factors for the long-term development of AF&#46; To our knowledge&#44; there is no study that has investigated the effect of iron deficiency anemia on P wave measurements&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">Compromised oxygen delivery capacity due to anemia may result in chronic tissue hypoxemia&#44; which may then lead to myocyte dysfunction&#46; Because iron moieties bind to myoglobin&#44; a total-body iron deficit could further impair the ability of myocytes to extract oxygen from circulating hemoglobin&#46; Several mechanisms operate to compensate for tissue hypoxia induced by anemia&#46; When the hemoglobin concentration drops below 10 g&#47;dl or during non-resting conditions&#44; non-hemodynamic factors are surmounted&#44; and hemodynamic mechanisms begin to compensate for tissue hypoxia&#46;<a class="elsevierStyleCrossRef" href="#bib21">21</a> Although increased cardiac output is the main hemodynamic factor and is mediated by lower afterload&#44; increased preload and positive inotropic and chronotropic affects&#44; the mechanisms of hemodynamic compensation are complex&#46; These mechanisms include &#40;i&#41; a reduction in afterload due to a decrease in systemic vascular resistance&#44; &#40;ii&#41; an increase in preload due to an increase in venous return and &#40;iii&#41; increased left ventricular &#40;LV&#41; function attributed to increased sympathetic activity and inotropic factors&#46; In addition&#44; heart rate is increased in anemic patients due to hypoxia-stimulated chemoreceptors&#46;<a class="elsevierStyleCrossRefs" href="#bib22">22&#44;23</a></p><p id="para140" class="elsevierStylePara elsevierViewall">In the present study&#44; the frequency of LV diastolic dysfunction was significantly increased in patients with IDA&#46; Several mechanisms may explain this association&#46; Tissue hypoxia induced by anemia may impair diastolic function&#46; Diastolic dysfunction without systolic dysfunction may present at an early stage of myocardial ischemia&#44; and this is consistent with the finding that left ventricular diastolic function is more susceptible to ischemia than systolic function&#46;<a class="elsevierStyleCrossRef" href="#bib24">24</a> Adaptation to an anemic state involves the augmentation of heart rate&#44; cardiac index&#44; stroke work and increased plasma volume&#46;<a class="elsevierStyleCrossRefs" href="#bib23">23&#44;25</a> This overall increase in sympathetic and inotropic activity places additional stress on the myocardium and may lead to the remodeling of myocytes and the vasculature&#46; Anemia also has numerous hormonal and metabolic effects that can result in direct myocardial toxicity and ischemia&#46;<a class="elsevierStyleCrossRef" href="#bib26">26</a> These specific effects have been observed when the anemia is severe &#40;Hb &#60;10 g&#47;dl&#41;&#46; Therefore&#44; subendocardial ischemia&#44; increased heart rate and altered loading conditions may contribute to the anemia-associated diastolic dysfunction&#46; LV diastolic dysfunction has also been shown to be associated with increased PWD and may partially explain our finding of increased PWD in IDA&#46;<a class="elsevierStyleCrossRef" href="#bib27">27</a></p><p id="para150" class="elsevierStylePara elsevierViewall">P wave duration and PWD have also been reported to be influenced by autonomic tone&#44; which induces changes in the velocity of impulse propagation&#46; Increased sympathetic activity causes a significant increase in PWD&#46;<a class="elsevierStyleCrossRef" href="#bib28">28</a> Elevated levels of norepinephrine in plasma and urine in IDA patients support the role of increased sympathetic activity in this effect&#46;<a class="elsevierStyleCrossRef" href="#bib29">29</a> Low oxygen tension in the tissues may explain the autonomic dysfunction in IDA&#46; Hypoxia has an important pathophysiological role in various diseases&#44; including anemia&#46;<a class="elsevierStyleCrossRef" href="#bib30">30</a> Cardiac autonomic dysfunction has been documented in various anemic patient populations&#44; such as those with vitamin B12 deficiency&#44; sickle cell anemia&#44; thalassemia and iron deficiency anemia&#46;<a class="elsevierStyleCrossRefs" href="#bib31">31&#44;32</a> Although it is unknown how low oxygen tension is detected by cells&#44; the influence of the carotid body on ventilatory and cardiovascular reflexes seems to play a major role in altered autonomic balance&#46;<a class="elsevierStyleCrossRef" href="#bib33">33</a></p><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Limitations</span><p id="para160" class="elsevierStylePara elsevierViewall">The most important limitation of our study is the manual calculation of P-wave measurements using a magnifying lens instead of computer-assisted P-wave calculations&#46; However&#44; thermal&#44; digital and signal-averaging ECG systems have been used to evaluate PWD&#44; which was measured manually either on paper or on a high-resolution computer screen&#46; Although several studies have demonstrated a low error in the measurement of PWD on paper-printed ECGs&#44; other studies have suggested that manual PWD measurement on paper-printed ECGs obtained at a standard signal size and paper speed may have questionable accuracy and reproducibility&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;34</a> It is unclear whether prolonged PWD may be associated with the long-term development of AF&#46; Pulsed wave Doppler indices used for the evaluation of LV diastolic properties have been known to be altered by numerous factors&#44; including loading conditions and heart rate&#44; both of which can be altered by anemia&#46;<a class="elsevierStyleCrossRef" href="#bib35">35</a> However&#44; to evaluate diastolic function&#44; we also used tissue Doppler indices&#44; which are relatively independent of loading conditions&#46;</p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">CONCLUSIONS</span><p id="para170" class="elsevierStylePara elsevierViewall">Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling&#46; Tissue hypoxia&#44; altered loading conditions and impaired autonomic balance with increased sympathetic activity may be among the possible mechanisms that explain these findings&#46;</p></span></span>"
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    "fechaRecibido" => "2010-05-13"
    "fechaAceptado" => "2010-08-02"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1581401"
          "palabras" => array:6 [
            0 => "Diastolic dysfunction"
            1 => "Electrocardiogram"
            2 => "Iron deficiency"
            3 => "Anemia"
            4 => "P wave"
            5 => "Dispersion"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES&#58;</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">The association between P wave dispersion and iron deficiency anemia has not been documented in the literature&#46; In this study&#44; we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">INTRODUCTION&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">The iron status of an individual may play an important role in cardiovascular health&#46; Anemia is an independent risk factor for adverse cardiovascular outcomes&#46; P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation&#46; Apart from cardiovascular diseases&#44; several conditions&#44; such as seasonal variation&#44; alcohol intake and caffeine ingestion&#44; have been demonstrated to affect P wave dispersion&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">METHODS&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">The study included 97 patients who had iron deficiency anemia and 50 healthy subjects&#46; The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Compared to the control group&#44; patients with iron deficiency anemia showed significantly longer maximum P wave duration &#40;Pmax&#41; &#40;91&#46;1&#177;18&#46;0 vs&#46; 85&#46;8&#177;6&#46;7 msec&#44; p &#61; 0&#46;054&#41;&#44; P wave dispersion &#40;PWD&#41; &#40;48&#46;1&#177;7&#46;7 vs&#46; 40&#46;9&#177;5&#46;6 msec&#44; p&#60;0&#46;001&#41;&#44; mitral inflow deceleration time &#40;DT&#41; &#40;197&#46;5&#177;27&#46;9 vs&#46; 178&#46;8&#177;8&#46;9 msec&#44; p&#60;0&#46;001&#41; and isovolumetric relaxation time &#40;IVRT&#41; &#40;93&#46;3&#177;9&#46;2 vs&#46; 77&#46;4&#177;8&#46;2 msec&#44; p&#60;0&#46;001&#41;&#59; they also showed increased heart rate &#40;85&#46;7&#177;16&#46;1 vs&#46; 69&#46;0&#177;4&#46;4&#44; p&#60;0&#46;001&#41; and frequency of diastolic dysfunction &#40;7 &#40;7&#46;2&#37;&#41; vs&#46; 0&#41;&#46; Correlation analysis revealed that PWD was significantly correlated with IVRT&#44; DT&#44; heart rate&#44; the presence of anemia and hemoglobin level&#46;</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSIONS&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "ceabs10"
            "titulo" => "OBJECTIVES&#58;"
          ]
          1 => array:2 [
            "identificador" => "ceabs20"
            "titulo" => "INTRODUCTION&#58;"
          ]
          2 => array:2 [
            "identificador" => "ceabs30"
            "titulo" => "METHODS&#58;"
          ]
          3 => array:2 [
            "identificador" => "ceabs40"
            "titulo" => "RESULTS&#58;"
          ]
          4 => array:2 [
            "identificador" => "ceabs50"
            "titulo" => "CONCLUSIONS&#58;"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig1-cln_65p1067"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 336
            "Ancho" => 415
            "Tamanyo" => 14716
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Correlation between hemoglobin level and P wave dispersion&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "t1-cln_65p1067"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">BP&#58; Blood pressure&#44; Hb&#58; Hemoglobin&#44; Htc&#58; Hematocrit&#44; LVDD&#58; Left ventricular diastolic diameter&#44; LVSD&#58; Left ventricular systolic diameter&#44; LVEF&#58; Left ventricular ejection fraction&#44; IVS&#58; Interventricular septum&#44; PW&#58; Posterior Wall&#44; LA&#58; Left atrium&#44; DT&#58; Deceleration time&#44; IVRT&#58; Isovolumetric relaxation time&#44; SI&#58; Serum Iron&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">IDA &#40;n &#61; 97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Control &#40;n &#61; 50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">P value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">37&#46;48&#177;11&#46;9&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  " align="char" valign="top">37&#46;28&#177;5&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">0&#46;816&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  " align="left" valign="top">Male &#40;n&#44;&#37;&#41;&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  " align="center" valign="top">30 &#40;30&#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="center" valign="top">13 &#40;26&#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="top">0&#46;824&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  " align="left" valign="top">Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">23&#46;3&#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
                  \t\t\t\t  " align="char" valign="top">24&#46;0&#177;1&#46;8&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="top">0&#46;194&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  " align="left" valign="top">Smoking &#40;n&#44;&#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="center" valign="top">20 &#40;20&#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="center" valign="top">14 &#40;28&#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="top">0&#46;483&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  " align="left" valign="top">Systolic BP &#40;mmHg&#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="top">117&#46;5&#177;9&#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="top">118&#46;0&#177;9&#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="top">0&#46;788&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  " align="left" valign="top">Diastolic BP &#40;mmHg&#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="top">73&#46;3&#177;8&#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="top">73&#46;3&#177;7&#46;8&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="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Hb &#40;g&#47;dl&#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="top">7&#46;9&#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="top">14&#46;2&#177;0&#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="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Htc &#40;&#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="top">25&#46;3&#177;4&#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="top">40&#46;3&#177;1&#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="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">LVDD &#40;mm&#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="top">48&#46;1&#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="char" valign="top">47&#46;7&#177;2&#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="top">0&#46;914&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  " align="left" valign="top">LVSD &#40;mm&#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="top">30&#46;8&#177;2&#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="char" valign="top">32&#46;6&#177;2&#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="top">0&#46;462&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  " align="left" valign="top">LVEF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">63&#46;0&#177;3&#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="top">63&#46;2&#177;2&#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="top">0&#46;385&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  " align="left" valign="top">IVS &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">9&#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="char" valign="top">9&#46;5&#177;0&#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="top">0&#46;297&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  " align="left" valign="top">PW &#40;mm&#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="top">9&#46;1&#177;1&#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="top">9&#46;4&#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="top">0&#46;178&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  " align="left" valign="top">LA diameter &#40;mm&#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="top">35&#46;6&#177;4&#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="char" valign="top">34&#46;4&#177;12&#46;8&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="top">0&#46;07&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  " align="left" valign="top">E&#47;A&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="top">1&#46;3&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1&#46;3&#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="top">0&#46;553&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  " align="left" valign="top">DT &#40;msec&#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="top">197&#46;5&#177;27&#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="top">178&#46;8&#177;8&#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="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">IVRT &#40;msec&#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="top">93&#46;3&#177;9&#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="top">77&#46;4&#177;8&#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="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Diastolic dysfunction &#40;n&#44;&#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="center" valign="top">7 &#40;7&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&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="top">0&#46;012&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  " align="left" valign="top">SI &#40;ug &#47;dl&#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="top">19&#46;50&#177;5&#46;10&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="top">76&#46;92&#177;23&#46;60&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="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Ferritin &#40;ng&#47;ml&#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="top">4&#46;54&#177;3&#46;51&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="top">42&#46;55&#177;47&#46;71&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="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Transferrin saturation &#40;&#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="top">8&#46;10&#177;2&#46;18&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="top">34&#46;23&#177;12&#46;14&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="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          ]
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          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Comparison of clinical and echocardiographic variables for patients with iron deficiency anemia versus healthy subjects&#46;</p>"
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">IDA &#40;n &#61; 97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Control &#40;n &#61; 50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">P value&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
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                  \t\t\t\t  " align="left" valign="top">Pmax &#40;msec&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">91&#46;1&#177;18&#46;0&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="top">85&#46;8&#177;6&#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="top">0&#46;054&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  " align="left" valign="top">P min &#40;msec&#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="top">44&#46;8&#177;9&#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="top">44&#46;9&#177;9&#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="top">0&#46;957&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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="top">48&#46;1&#177;7&#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="top">40&#46;9&#177;5&#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="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="top">Heart rate &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">85&#46;7&#177;16&#46;1&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</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
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          "bibliografiaReferencia" => array:35 [
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              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "P wave dispersion&#46; A valuable non-invasive marker of vulnerability to atrial arrhythmias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              PE Dilaveris \n
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                              """
                            1 => """
                              CI Stefanadis \n
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                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hospital Chronicles"
                        "fecha" => "2006"
                        "volumen" => "1"
                        "paginaInicial" => "130"
                        "paginaFinal" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "P wave assessment&#58; State of the art update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              A Michelucci \n
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                            1 => """
                              G Bagliani \n
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                            2 => """
                              A Colella \n
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                            3 => """
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                            4 => """
                              MC Porciani \n
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                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Card Electrophys Rev"
                        "fecha" => "2002"
                        "volumen" => "6"
                        "paginaInicial" => "215"
                        "paginaFinal" => "220"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1023&#47;A&#58;1016368723033"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "P wave dispersion on 12 lead electrocardiography in patients with paroxysmal atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              K Aytemir \n
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                              """
                            1 => """
                              N Ozer \n
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                              """
                            2 => """
                              E Atalar \n
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                              """
                            3 => """
                              E Sade \n
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                              """
                            4 => """
                              S Aks&#246;yek \n
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                              """
                            5 => """
                              K Ov&#252;n&#231; \n
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                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2000"
                        "volumen" => "23"
                        "paginaInicial" => "1109"
                        "paginaFinal" => "1112"
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                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1111&#47;j&#46;1540-8159&#46;2000&#46;tb00910&#46;x"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal variation of P wave dispersion in healthy subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              S Kose \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              K Aytemir \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              I Can \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Iyisoy \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Kilic \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              B Amasyali \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1054/jelc.2002.35848"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Electrocardiol"
                        "fecha" => "2002"
                        "volumen" => "35"
                        "paginaInicial" => "307"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12395357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1054/jelc.2002.35848"
                      "WWW" => array:1 [
                        "link" => "10&#46;1054&#47;jelc&#46;2002&#46;35848"
                      ]
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                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute alcohol intake and P-wave dispersion in healthy men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              H Uyarel \n
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                              """
                            1 => """
                              C Ozdol \n
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                              """
                            2 => """
                              A Karabulut \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              E Okmen \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              N Cam \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anadolu Kardiyol Derg"
                        "fecha" => "2005"
                        "volumen" => "5"
                        "paginaInicial" => "289"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16330394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An evaluation of the change in electrocardiographic P-wave variables after acute caffeine ingestion in normal volunteers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              MF Caron \n
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                              """
                            1 => """
                              J Song \n
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                              """
                            2 => """
                              R Ammar \n
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                              """
                            3 => """
                              J Kluger \n
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                              """
                            4 => """
                              CM White \n
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                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Pharm Ther"
                        "fecha" => "2001"
                        "volumen" => "26"
                        "paginaInicial" => "145"
                        "paginaFinal" => "148"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1046&#47;j&#46;1365-2710&#46;2001&#46;00336&#46;x"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Kidney disease as a risk factor for development of cardiovascular disease&#58; a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease&#44; High Blood Pressure Research&#44; Clinical Cardiology&#44; and Epidemiology and Prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MJ Sarnak \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AS Levey \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AC Schoolwerth \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J Coresh \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              B Culleton \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              LL Hamm \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000095676.90936.80"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "108"
                        "paginaInicial" => "2154"
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Article information
ISSN: 18075932
Original language: English
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