Original
Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery
Acuerdo interobservador de los parámetros ecocardiográficos que estiman la función sistólica del ventrículo derecho en el postoperatorio temprano de cirugía cardiaca
S.G. Olmos-Temoisa, L.E. Santos-Martíneza,b,
, R. Álvarez-Álvareza, L.G. Gutiérrez-Delgadoa, F.M. Baranda-Tovara
Corresponding author
a Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», Mexico City, Mexico
b Unidad Médica de Alta Especialidad, Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social , Mexico City, Mexico
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(A) Apical four-chamber view. In this view must check the left atrium volume and size and the left ventricle and septum size. (B) Apical four-chamber view, circle shows position where pulse wave Doppler has to be placed to measure transmitral flow, whereas rectangles show position where tissue Doppler must be placed to measure the velocity of change in myocardial length. (C) Pulse wave mitral Doppler at the tip of the mitral valve showing a normal diastolic pattern with a biphasic velocity profile <span class="elsevierStyleItalic">E</span> and <span class="elsevierStyleItalic">A</span> waves. Measurement of <span class="elsevierStyleItalic">E</span> wave deceleration time. (D) Tissue Doppler measurement at the lateral insertion site of the mitral leaflets shows the diastolic <span class="elsevierStyleItalic">e</span>′ and <span class="elsevierStyleItalic">a</span>′ waves and systolic <span class="elsevierStyleItalic">s</span>′ wave. 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Olmos-Temois, L.E. Santos-Martínez, R. Álvarez-Álvarez, L.G. Gutiérrez-Delgado, F.M. Baranda-Tovar" "autores" => array:5 [ 0 => array:3 [ "nombre" => "S.G." "apellidos" => "Olmos-Temois" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "L.E." "apellidos" => "Santos-Martínez" "email" => array:1 [ 0 => "luis.santosma@imss.gob.mx" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Álvarez-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L.G." "apellidos" => "Gutiérrez-Delgado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "F.M." "apellidos" => "Baranda-Tovar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Médica de Alta Especialidad, Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social , Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acuerdo interobservador de los parámetros ecocardiográficos que estiman la función sistólica del ventrículo derecho en el postoperatorio temprano de cirugía cardiaca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1235 "Ancho" => 1618 "Tamanyo" => 155936 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman analysis of tricuspid annular plane systolic excursion (TAPSE) using tissue Doppler ultrasound. SD: standard deviation; TAPSE 1: tricuspid annular plane systolic excursion obtained using tissue Doppler by observer 1; TAPSE 2: tricuspid annular plane systolic excursion obtained using tissue Doppler by observer 2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The study of right ventricular systolic function (RVSF) is complicated due to the shape and position of the right ventricle (RV) in the thorax.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1,2</span></a> Noninvasive evaluation can be made using echocardiography. In this regard, a recent publication<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> has defined the echocardiographic parameters needed for reliable and objective evaluation, in contraposition to visual assessment, which although frequently used in clinical practice, is subjective and therefore influenced by inherent interobserver variability.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> These parameters have been studied in contexts other than the postoperative phase of heart surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In contrast to transesophageal echocardiography (TEE), transthoracic echocardiography (TTE) is noninvasive and painless, and can be performed repeatedly. Furthermore, in the same way as TEE, it does not involve ionizing radiation and to date has not been shown to have any biological effects.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> This diagnostic technique is increasingly used in Intensive Care Units (ICUs),<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> specifically in cardiovascular ICUs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Heart surgery patients often experience alterations in RVSF,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7–12</span></a> and such alterations have been identified as predictors of patient morbidity, severe hemodynamic changes and even death.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Experience with the use of TTE in this patient population is very limited. To the best of our knowledge, the only study published to date on TTE and the postoperative phase of heart surgery<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> defined the technique as a useful tool for guiding treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the presurgical context of mitral valve surgery,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> both tricuspid annular plane systolic excursion (TAPSE) and the tricuspid annular peak systolic velocity (TAPSV) measured by tissue Doppler have been the most reliable parameters for evaluating RVSF. In the late postoperative period (>6 months) of mitral valve surgery, RV function and systolic and diastolic volumes determined by three-dimensional echocardiography have been shown to be useful and reliable.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> In the postoperative phase of large artery transposition and atrial redirecting surgery, interobserver variation was found to be great, with an increasing tendency to overestimate the echocardiographic parameters of RVSF.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The characteristics inherent to the RV and a poor acoustic window have made it difficult to obtain adequate images for analysis in the nonsurgical context.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14–17</span></a> However, even in the presence of a good acoustic window, interobserver variability can be great if subjective methods are used for assessment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the postoperative period of cardiovascular surgery it is not clear whether mechanical ventilation (MV), overweight, and the presence of mediastinal and/or pleural drains can affect the acoustic window and thus the possibility of obtaining adequate echocardiographic images for analyzing RV function.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In view of the above, the present study was carried out to determine the feasibility of obtaining the echocardiographic indices related to RVSF, and to describe the interobserver variability of these parameters in individuals in the early postoperative phase of heart surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Patients and methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study was carried out in the Cardiovascular Postsurgery Intensive Care Unit of «Ignacio Chávez» National Cardiology Institute, in México D.F. (Mexico), between August 2012 and February 2013.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A cross-sectional, double-blind pilot study was designed, with consecutive non-probabilistic sampling. Patients between 18 and 75 years of age in the postoperative phase of myocardial revascularization and mitral, aortic or mitral-aortic valve replacement surgery in «Ignacio Chávez» National Cardiology Institute were included. All the echocardiographic data were acquired between 6 and 8<span class="elsevierStyleHsp" style=""></span>h after surgery. The following exclusion criteria were applied: patients with active bleeding, packing measures due to mediastinal hemorrhage or hemodynamic instability (mean systemic blood pressure <60<span class="elsevierStyleHsp" style=""></span>mmHg).</p><p id="par0055" class="elsevierStylePara elsevierViewall">All the TTE parameters were obtained by the same investigators (SGOT and RJAA)–both cardiologists with formal training in echocardiography. The numerical values corresponding to the study variables were blinded between observers, and the order of data collection was established by simple randomization.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The parameters evaluated by TTE and related to RVSF<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3,15</span></a> were: TAPSE (mm), TAPSV (m/s), diastolic and systolic diameter of the RV (DDRV and SDRV, respectively)(mm), right ventricular diameter shortening fraction (RVDSF)(%), diastolic and systolic area of the RV (DARV, SARV)(cm<span class="elsevierStyleSup">2</span>), right ventricular area shortening fraction (RVASF, %), diastolic and systolic diameter of the right ventricular outflow tract (DDRVOT and SDRVOT, respectively)(mm), right ventricular outflow tract shortening fraction (RVOTSF)(%), diastolic and systolic diameter of the left ventricle (DDLV and SDLV, respectively)(mm), and the right ventricle/left ventricle ratio (RV/LV).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The parameters were quantified according to the guides of the American Society of Echocardiography for evaluation of the right side of the heart<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a>: TAPSE in apical plane four-chamber M-mode; TAPSV using apical plane four-chamber tissue Doppler with sample volume in the tricuspid ring; RV areas in apical plane four-chamber mode; RV diastolic and systolic diameters in apical plane four-chamber mode in the basal region of the RV; and RV outflow tract in the short parasternal axis at large vessel level.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In all cases we used the VIVID E9 cardiovascular ultrasound system with the M5S-D sectorial cardiac probe (GE Vingmed Ultrasound A/S, Strandpromenaden 45, N-3191 Norten, Norway) and 1.5–4.6<span class="elsevierStyleHsp" style=""></span>MHz transducer. The images were acquired with tissue harmonics. No ultrasound contrast was used to improve visualization of the endocardial margins.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The patients signed the informed consent form before surgery, and the study was approved by the Ethics Committee of «Ignacio Chávez» National Cardiology Institute.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Both observers obtained the different study parameters after ensuring normalization of the hemodynamic parameters in the first 6–8<span class="elsevierStyleHsp" style=""></span>h after surgery, with the patient in supine decubitus and without any therapeutic maneuvering capable of modifying the echocardiographic recordings. A third participant, unrelated to the measurements, entered the results in the database.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Statistical analysis: Numerical values were reported as the mean and standard deviation, while nominal variables were expressed as frequencies and percentages.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Interobserver variability was analyzed based on the mean difference and limits according to the Bland–Altman statistical procedure.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18,19</span></a> Its magnitude was calculated with the intraclass correlation coefficient (ICC) and corresponding 95% confidence interval (95%CI).<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">19,20</span></a> Almost perfect agreement was defined as ICC 0.81–1.0; substantial agreement as ICC 0.61–0.80; moderate agreement as ICC 0.41–0.6; regular agreement as ICC 0.21–0.4; slight agreement as 0.01–0.2; and poor agreement as ICC 0.0.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 56 post-heart surgery patients were enrolled, of which four were excluded due to the presence of extreme acoustic window conditions (no observer was able to perform the measurements). A total of 52 subjects where therefore finally analyzed, of which the majority (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30; 58%) were males. The demographic, clinical and surgical characteristics are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The study population was overweight and presented other comorbidities. The predominant type of procedure was valve surgery. Mediastinal drains were placed in all cases. Most patients had two pleural drains (left and right), and almost one-half (48%) were on MV during recording of the echocardiographic data.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The four subjects in which no echocardiographic measurements could be obtained were all subjected to MV, with mediastinal and pleural drains at the time of recording, and three were moreover overweight.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The mean TAPSE in the overall group of patients was 11.68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.53<span class="elsevierStyleHsp" style=""></span>mm (minimum 4<span class="elsevierStyleHsp" style=""></span>mm and maximum 27<span class="elsevierStyleHsp" style=""></span>mm). In 7 patients (15%) the data were in the normal range (TAPSE<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>mm), while 41 (85%) presented right ventricular systolic dysfunction (<17<span class="elsevierStyleHsp" style=""></span>mm).<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> Specifically, in these cases right ventricular systolic dysfunction proved mild (TAPSE<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mm, <17<span class="elsevierStyleHsp" style=""></span>mm) in 18 (37.5%), moderate (≥7<span class="elsevierStyleHsp" style=""></span>mm, <12<span class="elsevierStyleHsp" style=""></span>mm) in 19 (39.5%), and severe (<7<span class="elsevierStyleHsp" style=""></span>mm) in four patients (8%).</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study series the frequency of the evaluated echocardiographic variables proved inconstant for either of the two observers, as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Only TAPSE and TAPSV could be determined in over 90% of the cases.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The respective ICC (95%CI) of these parameters are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. In turn, <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the echocardiographic parameters exhibiting the greatest ICC (>0.61, corresponding to substantial agreement), the mean differences, limits of agreement and values corresponding to ICC (95%CI).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The Bland–Altman plots of the three echocardiographic parameters exhibiting substantial agreement (ICC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.61) are shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0020">Tables 4 and 5</a> show the number of patients in which it was possible and not possible to study the different RVSF parameters stratified according to observer 1 or 2, the presence or absence of MV, and the presence or absence of overweight as established from the body mass index.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The estimation of RVSF has become a need in presurgical and postsurgical patients, due to its importance in defining the prognosis of heart surgery.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The limiting factors for the study of RVSF, such as the anatomical complexity of the ventricle and its location in the thorax, constitute a challenge for any study method. At present, cardiac magnetic resonance imaging is regarded as the gold standard for global assessment of systolic function.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> However, due to its limitations in relation to safety, technical factors, availability and time, the use of cardiac magnetic resonance imaging is not feasible in certain clinical scenarios such as for example the postoperative phase of cardiovascular surgery.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Thanks to its widespread availability and easy application in experienced hands, echocardiography is becoming the tool of choice for functional cardiac and hemodynamic assessment in the ICU.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5,23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Our study population has a number of special features: serious clinical conditions with SDRV in the order of 85%; the need for MV; the presence of mediastinal and/or pleural drains; and excess body weight – all these being factors that can increase interobserver variability due to the lack of an adequate acoustic window.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14–17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">All of the patients had mediastinal drains, and the majority moreover also had two pleural drains (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Almost one-half were evaluated while on mechanical ventilation (with endotracheal tube), and the four subjects in which no measurements could be obtained were all on MV. On the other hand, the mean body mass index indicated overweight/obesity among the subjects. These characteristics appear to influence the increased estimated interobserver variability in this patient group.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5,22</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that TAPSE and TAPSV could be studied in 90% of the patients, while the least measurable of the rest of the parameters were found to be RVOTSF and DDRVOT and SDRVOT.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Calculation of ICC revealed substantial agreement of TAPSV, TAPSE, DARV, SARV, RV/LV, DDRVOT and SDRVOT (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). However, TAPSV and TAPSE demonstrated the best ICC values. Although the right ventricular diastolic and systolic area measurements presented ICC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.61, they were not taken into account for the analysis because their corresponding shortening values (which determine systolic functional status, RVOTSF) showed the lowest ICC. The RV/LV ratio presented a ICC value of 0.69, and could be estimated in 65% of the patients; accordingly, it may be regarded as the third most reliable parameter in assessing RVSF.</p><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> show the mean difference in TAPSV to be very small, in the same way as its limits of agreement. In contrast, TAPSE, with a mean difference of close to −1, showed broad limits of agreement (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In turn, the RV/LV ratio presented a mean difference of close to zero, with slightly broad limits of agreement, as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The results shown in <a class="elsevierStyleCrossRefs" href="#tbl0020">Tables 4 and 5</a> suggest that MV and overweight affect the obtainment of adequate acoustic windows with TTE, and the association of both parameters appears to more deleterious for imaging quality than either parameter used separately – this being reflected in the increased interobserver variability.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The data of our study demonstrate the feasibility of obtaining echocardiographic indices such as TAPSV and TAPSE in this critical patient population, as well as the increased interobserver variability of the rest of the echocardiographic parameters studied. This interobserver variability is greater than in patients not subjected to heart surgery.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13–17</span></a> However, such variability is no greater than that observed when estimating RVSF visually in other disease scenarios.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Transesophageal echocardiography could be used in patients with a poor acoustic window.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> The use of three-dimensional echocardiography<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> likewise could be an option specifically for calculating volumes or ejection fractions–though its use is limited by the fact that it requires good echocardiographic windows and longer times to analyze RVSF, and is moreover expensive to acquire and maintain in the ICU.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Our study indicates that in this group of postsurgery patients, TAPSV is the RVSF echocardiographic parameter with the least interobserver variability, followed by TAPSE – although its limit of agreement is greater–and the RV/LV ratio in third place, though the feasibility of obtaining this parameter limits its use.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Given the lesser interobserver variability and the large number of patients in which TAPSV and TAPSE can be obtained, the use of TTE on a first intention basis for the assessment of this concrete group of patients appears to be justified.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Study limitations</span><p id="par0195" class="elsevierStylePara elsevierViewall">Our study has limitations, related mainly to the sample size involved. Nevertheless, the sample allowed us to observe the important interobserver variability of most of the parameters used to assess RVSF using TTE. The measurements were made by cardiologists trained in echocardiography, and hence the results might not be extrapolatable to those obtained by cardiologists without such training or by intensivists trained in echocardiography. Inclusion and comparison with the visual estimation of RVSF–perhaps the most widely used method in routine practice–was not carried out, since we aimed to eliminate the subjectiveness of observation. In this regard, we based our study on objective measurements of RVSF. Lastly, all the measurements were made with the patient in supine decubitus, and this may have limited the obtainment of better quality acoustic windows if patient positioning in left lateral decubitus had been possible.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">Our study identifies TAPSV and TAPSE as the RVSF indices with the least interobserver variability and the greatest measurement feasibility in patients in the early postoperative phase of heart surgery.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres752658" "titulo" => "Abstract" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Primary objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Secondary objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Design" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Setting" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Patients" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Intervention" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Main variables" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec755015" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres752657" "titulo" => "Resumen" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "abst0050" "titulo" => "Objetivo primario" ] 1 => array:2 [ "identificador" => "abst0055" "titulo" => "Objetivo secundario" ] 2 => array:2 [ "identificador" => "abst0060" "titulo" => "Diseño" ] 3 => array:2 [ "identificador" => "abst0065" "titulo" => "Ámbito" ] 4 => array:2 [ "identificador" => "abst0070" "titulo" => "Pacientes" ] 5 => array:2 [ "identificador" => "abst0075" "titulo" => "Intervención" ] 6 => array:2 [ "identificador" => "abst0080" "titulo" => "Variables de interés" ] 7 => array:2 [ "identificador" => "abst0085" "titulo" => "Resultados" ] 8 => array:2 [ "identificador" => "abst0090" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec755016" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-05" "fechaAceptado" => "2016-02-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec755015" "palabras" => array:5 [ 0 => "Echocardiography" 1 => "Right ventricular function" 2 => "Cardiac surgery" 3 => "Reliability" 4 => "Interobserver variability" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec755016" "palabras" => array:5 [ 0 => "Ecocardiografía" 1 => "Función del ventrículo derecho" 2 => "Cirugía cardiaca" 3 => "Fiabilidad" 4 => "Variabilidad interobservador" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Primary objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Secondary objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the feasibility of these echocardiographic measurements.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Setting</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular postoperative critical care at the National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Intervention</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The first echocardiographic parameters were obtained between 6 and 8<span class="elsevierStyleHsp" style=""></span>h after cardiac surgery, followed by blinded second measurements.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Main variables</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland–Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.53<span class="elsevierStyleHsp" style=""></span>mm (range 4–27<span class="elsevierStyleHsp" style=""></span>mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were −0.917<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.95 (−6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was −0.001<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.015 (−0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability.</p></span>" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Primary objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Secondary objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Design" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Setting" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Patients" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Intervention" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Main variables" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Objetivo primario</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Conocer la variabilidad interobservador de los parámetros ecocardiográficos transtorácicos que evalúan la función sistólica del ventrículo derecho en sujetos en el postoperatorio temprano de cirugía cardiaca.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Objetivo secundario</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evaluar la factibilidad en la medición de estos parámetros ecocardiográficos.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Diseño</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Piloto, transversal, doble ciego. Mayo de 2011 a febrero de 2013.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ámbito</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México (México).</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Muestreo no probabilístico, consecutivo, se estudiaron 56 pacientes postoperados de cirugía cardiaca.</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intervención</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Entre 6 a 8 h después de la intervención de cirugía cardiaca se obtuvieron los parámetros ecocardiográficos. La segunda medición se realizó a posteriori, de forma cegada.</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables de interés</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Excursión sistólica del plano valvular tricuspídeo (TAPSE), velocidad sistólica pico del anillo tricuspídeo medida por Doppler tisular (VSPAT), diámetros y fracción de acortamiento del tracto de salida del ventrículo derecho. La variabilidad interobservador y su magnitud se obtuvieron con el procedimiento de Bland-Altman y el coeficiente de correlación intraclase (intervalo de confianza del 95%).</p></span> <span id="abst0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">El TAPSE y la VSPAT se pudieron estudiar por ambos observadores en 48 (92%) de los sujetos. El promedio del TAPSE fue 11,68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,53<span class="elsevierStyleHsp" style=""></span>mm con valor mínimo-máximo de 4 a 27<span class="elsevierStyleHsp" style=""></span>mm. Se encontró disfunción sistólica del ventrículo derecho en 41 (85%) y TAPSE normal en 7 (15%) pacientes. La diferencia media y sus límites de acuerdo del TAPSE fueron -0,917<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,95 (–6,821; 4,988), y su magnitud de 0,725 (0,552; 0,837). Los valores de VSPAT fueron –0,001± 0,015 (–0,031; 0,030) con magnitud de 0,825 (0,708; 0,898) respectivas.</p></span> <span id="abst0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Fue posible estimar el TAPSE y la VSPAT por parte de ambos observadores en el 92% de los sujetos. Estos índices ecocardiográficos tuvieron la menor variabilidad interobservador en sujetos postoperados de cirugía cardiaca.</p></span>" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "abst0050" "titulo" => "Objetivo primario" ] 1 => array:2 [ "identificador" => "abst0055" "titulo" => "Objetivo secundario" ] 2 => array:2 [ "identificador" => "abst0060" "titulo" => "Diseño" ] 3 => array:2 [ "identificador" => "abst0065" "titulo" => "Ámbito" ] 4 => array:2 [ "identificador" => "abst0070" "titulo" => "Pacientes" ] 5 => array:2 [ "identificador" => "abst0075" "titulo" => "Intervención" ] 6 => array:2 [ "identificador" => "abst0080" "titulo" => "Variables de interés" ] 7 => array:2 [ "identificador" => "abst0085" "titulo" => "Resultados" ] 8 => array:2 [ "identificador" => "abst0090" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Olmos-Temois SG, Santos-Martínez LE, Álvarez-Álvarez R, Gutiérrez-Delgado LG, Baranda-Tovar FM. Acuerdo interobservador de los parámetros ecocardiográficos que estiman la función sistólica del ventrículo derecho en el postoperatorio temprano de cirugía cardiaca. Med Intensiva. 2016;40:491–498.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1216 "Ancho" => 1651 "Tamanyo" => 159925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman analysis of tricuspid annular peak systolic velocity (TAPSV) using tissue Doppler ultrasound. SD: standard deviation; TAPSV 1: tricuspid annular peak systolic velocity obtained using tissue Doppler by observer 1; TAPSV 2: tricuspid annular peak systolic velocity obtained using tissue Doppler by observer 2.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1235 "Ancho" => 1618 "Tamanyo" => 155936 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman analysis of tricuspid annular plane systolic excursion (TAPSE) using tissue Doppler ultrasound. SD: standard deviation; TAPSE 1: tricuspid annular plane systolic excursion obtained using tissue Doppler by observer 1; TAPSE 2: tricuspid annular plane systolic excursion obtained using tissue Doppler by observer 2.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1209 "Ancho" => 1636 "Tamanyo" => 140784 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman analysis of the right ventricle/left ventricle ratio (RV/LV). SD: standard deviation; RV/LV 1: right ventricle/left ventricle ratio obtained by observer 1; RV/LV 2: right ventricle/left ventricle ratio obtained by observer 2.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">The figures express the mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation or frequency (percentage).</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">CRVS: coronary revascularization surgery; CV: valve replacement; n (%); BMI: body mass index; AoR: aortic valve replacement.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Males (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.63<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.22<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (17.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRVS (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valve surgery (VR, CRVS<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>VR, AoR) (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor resection (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mediastinal drain (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 pleural drain (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 pleural drains (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (48) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245694.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Demographic, clinical and surgical characteristics of the patients.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">DARV, diastolic area of the RV; SARV, systolic area of the RV; ICC (95%CI), intraclass correlation coefficient (95% confidence interval); DDRVOT, diastolic diameter of the right ventricular outflow tract; DDRV, diastolic diameter of the right ventricle (RV); DDLV, diastolic diameter of the left ventricle (LV); SDRVOT, systolic diameter of the right ventricular outflow tract; SDRV; systolic diameter of the RV; SDLV, systolic diameter of the LV; RVASF right ventricular area shortening fraction; RVDSF, right ventricular diameter shortening fraction; RVOTSF, right ventricular outflow tract shortening fraction; LVEF, left ventricular ejection fraction<span class="elsevierStyleSmallCaps">;</span> TAPSE, tricuspid annular plane systolic excursion; RV/LV, right ventricle/left ventricle ratio; TAPSV, tricuspid annular peak systolic velocity measured by tissue Doppler ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Measure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 1<br>n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 2<br>n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Both<br>n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICC<br>(95%CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSV, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (92.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.825 (0.708, 0.898) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (92.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.725 (0.552, 0.837) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV/LV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (59.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.699 (0.467, 0.842) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.653 (0.447, 0.793) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.621 (0.405, 0.771) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVASF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.375 (0.085, 0.598) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (84.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.593 (0.361, 0.756) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (84.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.488 (0.227, 0.684) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FACD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (84.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.388 (0.105, 0.613) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.728 (0.470, 0.871) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.622 (0.318, 0.812) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVOTSF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.467 (0.114, 0.720) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245696.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Number of subjects in which the echocardiographic parameters could be obtained according to each observer, both observers jointly, and the magnitude of interobserver variability with the corresponding 95% confidence interval.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">ICC (95%CI), intraclass correlation coefficient (95% confidence interval); TAPSE, tricuspid annular plane systolic excursion; RV/LV, right ventricle/left ventricle ratio; TAPSV, tricuspid annular peak systolic velocity measured by tissue Doppler ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Measure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 1<br>(X¯)±SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 2<br>(X¯)±SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean difference<br>(X¯)±SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limits of agreement \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSV, m/s (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.025 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.001<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.031, 0.030 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE, mm (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.917<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−6.821, 4.988 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV/<span class="elsevierStyleSmallCaps">LV</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.028<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.276, 0.219 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245697.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Means and standard deviations, mean differences and limits of agreement of the echocardiographic parameters with the best intraclass correlation coefficients obtained.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">DARV, diastolic area of the right ventricle (RV); SARV, systolic area of the RV; DDRVOT, diastolic diameter of the right ventricular outflow tract; DDRV, diastolic diameter of the RV; SDRVOT, systolic diameter of the right ventricular outflow tract; SDRV, systolic diameter of the RV; RVASF right ventricular area shortening fraction; RVDSF, right ventricular diameter shortening fraction; RVOTSF, right ventricular outflow tract shortening fraction; BMI, body mass index; Observer 1 (yes), the variables could be measured; Observer 1 (no), the variables could not be measured; TAPSE, tricuspid annular plane systolic excursion; RV/LV, right ventricle/left ventricle ratio; MV (yes), with mechanical ventilation; MV (no), without mechanical ventilation; TAPSV, tricuspid annular peak systolic velocity measured by tissue Doppler ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Measure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 1 (Yes)</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 1 (No)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (yes)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (no)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (yes)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (no)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSV, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV/LV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVOTSF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVASF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVDSF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245693.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Number of patients in which it proved possible and impossible to study the different right ventricular systolic function parameters with respect to observer 1, the presence or absence of mechanical ventilation, and the presence or absence of overweight.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">DARV, diastolic area of the right ventricle (RV); SARV, systolic area of the RV; DDRVOT, diastolic diameter of the right ventricular outflow tract; DDRV, diastolic diameter of the RV; SDRVOT, systolic diameter of the right ventricular outflow tract; SDRV, systolic diameter of the RV; RVASF right ventricular area shortening fraction; RVDSF, right ventricular diameter shortening fraction; RVOTSF, right ventricular outflow tract shortening fraction; BMI, body mass index; Observer 2 (yes), the variables could be measured; Observer 2 (no), the variables could not be measured; TAPSE, tricuspid annular plane systolic excursion; RV/LV, right ventricle/left ventricle ratio; MV (yes), with mechanical ventilation; MV (no), without mechanical ventilation; TAPSV, tricuspid annular peak systolic velocity measured by tissue Doppler ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Measure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 2 (yes)</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Observer 2 (no)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (yes)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (no)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (yes)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MV (no)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>24.9 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSV, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV/LV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVOTSF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVASF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVDSF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SARV, cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRV, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SDRVOT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245695.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Number of patients in which it proved possible and impossible to study the different right ventricular systolic function parameters with respect to observer 2, the presence or absence of mechanical ventilation, and the presence or absence of overweight.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hipertensión pulmonar posoperatoria y síndrome de bajo gasto cardiaco derecho" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 12 | 24 |
| 2024 October | 64 | 42 | 106 |
| 2024 September | 54 | 36 | 90 |
| 2024 August | 70 | 53 | 123 |
| 2024 July | 54 | 27 | 81 |
| 2024 June | 76 | 57 | 133 |
| 2024 May | 51 | 49 | 100 |
| 2024 April | 50 | 40 | 90 |
| 2024 March | 48 | 30 | 78 |
| 2024 February | 38 | 42 | 80 |
| 2024 January | 41 | 30 | 71 |
| 2023 December | 36 | 39 | 75 |
| 2023 November | 44 | 36 | 80 |
| 2023 October | 40 | 29 | 69 |
| 2023 September | 40 | 37 | 77 |
| 2023 August | 28 | 22 | 50 |
| 2023 July | 38 | 20 | 58 |
| 2023 June | 26 | 19 | 45 |
| 2023 May | 47 | 37 | 84 |
| 2023 April | 53 | 26 | 79 |
| 2023 March | 68 | 35 | 103 |
| 2023 February | 79 | 31 | 110 |
| 2023 January | 56 | 20 | 76 |
| 2022 December | 95 | 31 | 126 |
| 2022 November | 84 | 37 | 121 |
| 2022 October | 89 | 37 | 126 |
| 2022 September | 68 | 31 | 99 |
| 2022 August | 56 | 45 | 101 |
| 2022 July | 57 | 40 | 97 |
| 2022 June | 66 | 25 | 91 |
| 2022 May | 63 | 46 | 109 |
| 2022 April | 107 | 50 | 157 |
| 2022 March | 81 | 49 | 130 |
| 2022 February | 81 | 26 | 107 |
| 2022 January | 77 | 50 | 127 |
| 2021 December | 77 | 45 | 122 |
| 2021 November | 76 | 38 | 114 |
| 2021 October | 76 | 77 | 153 |
| 2021 September | 47 | 29 | 76 |
| 2021 August | 47 | 41 | 88 |
| 2021 July | 57 | 32 | 89 |
| 2021 June | 43 | 27 | 70 |
| 2021 May | 65 | 41 | 106 |
| 2021 April | 134 | 94 | 228 |
| 2021 March | 98 | 39 | 137 |
| 2021 February | 61 | 36 | 97 |
| 2021 January | 51 | 19 | 70 |
| 2020 December | 38 | 19 | 57 |
| 2020 November | 55 | 20 | 75 |
| 2020 October | 24 | 28 | 52 |
| 2020 September | 33 | 26 | 59 |
| 2020 August | 41 | 23 | 64 |
| 2020 July | 32 | 13 | 45 |
| 2020 June | 50 | 17 | 67 |
| 2020 May | 43 | 11 | 54 |
| 2020 April | 42 | 17 | 59 |
| 2020 March | 56 | 12 | 68 |
| 2020 February | 180 | 32 | 212 |
| 2020 January | 52 | 31 | 83 |
| 2019 December | 65 | 26 | 91 |
| 2019 November | 44 | 32 | 76 |
| 2019 October | 41 | 21 | 62 |
| 2019 September | 48 | 20 | 68 |
| 2019 August | 56 | 23 | 79 |
| 2019 July | 32 | 25 | 57 |
| 2019 June | 30 | 8 | 38 |
| 2019 May | 59 | 34 | 93 |
| 2019 April | 31 | 27 | 58 |
| 2019 March | 34 | 23 | 57 |
| 2019 February | 31 | 36 | 67 |
| 2019 January | 36 | 30 | 66 |
| 2018 December | 44 | 55 | 99 |
| 2018 November | 177 | 90 | 267 |
| 2018 October | 137 | 24 | 161 |
| 2018 September | 50 | 9 | 59 |
| 2018 August | 22 | 7 | 29 |
| 2018 July | 23 | 9 | 32 |
| 2018 June | 27 | 4 | 31 |
| 2018 May | 19 | 5 | 24 |
| 2018 April | 25 | 6 | 31 |
| 2018 March | 17 | 8 | 25 |
| 2018 February | 18 | 8 | 26 |
| 2018 January | 31 | 6 | 37 |
| 2017 December | 24 | 5 | 29 |
| 2017 November | 27 | 6 | 33 |
| 2017 October | 35 | 9 | 44 |
| 2017 September | 18 | 6 | 24 |
| 2017 August | 25 | 9 | 34 |
| 2017 July | 28 | 14 | 42 |
| 2017 June | 28 | 9 | 37 |
| 2017 May | 29 | 21 | 50 |
| 2017 April | 61 | 17 | 78 |
| 2017 March | 13 | 1 | 14 |
| 2017 February | 7 | 0 | 7 |
| 2016 November | 2 | 3 | 5 |
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