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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0015" class="elsevierStylePara elsevierViewall">BACKGROUND Left ventricular &#40;LV&#41; trabeculation is highly variable among individuals and is increased in some diseases &#40;e&#46;g&#46;&#44; congenital heart disease or cardiomyopathies&#41;&#44; but its significance in population-representative individuals is unknown&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">OBJECTIVES The goal of this study was to determine if excessive LV trabeculation in population-representative individuals is associated with preceding changes in cardiac volumes and function&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">METHODS For technical reasons&#44; the extent of trabeculation&#44; which is expressed as the ratio of noncompacted to compacted &#40;NC&#47;<span class="elsevierStyleSmallCaps">C</span>&#41; myocardium&#44; was measured on cardiac magnetic resonance &#40;CMR&#41; long-axis cine images in 2&#44;742 participants in the MESA &#40;Multi-Ethnic Study of Atherosclerosis&#41; &#40;mean age 68&#46;7 years&#59; 52&#46;3&#37; women&#59; 56&#46;4&#37; with hypertension&#59; 16&#46;8&#37; with diabetes&#41; at examination 5&#46; These were considered in quintiles of trabeculation extent&#59; the NC&#47;C ratio of quintile 5 was 2&#46;46 to 5&#46;41&#46; We determined the relationship between the maximal NC&#47;C ratio and the preceding change &#40;9&#46;5 years between examinations 1 and 5&#41; in end-systolic volume indexed &#40;ESVi&#41; to body surface area&#46; Secondary analyses assessed the associations between the maximal NC&#47;C ratio and preceding changes in end-diastolic volume indexed &#40;EDVi&#41; to body surface area and the ejection fraction &#40;EF&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">RESULTS Over 9&#46;5 years&#44; the ESVi decreased by 1&#46;3<span class="elsevierStyleHsp" style=""></span>ml&#47;m2&#44; the EDVi decreased by 5&#46;1<span class="elsevierStyleHsp" style=""></span>ml&#47;m2&#44; and the EF decreased by 0&#46;6&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Even in subjects with excessive trabeculation&#44; there were no clinically relevant differences in LV volumes and systolic function changes among the quintiles of trabeculation extent&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">CONCLUSIONS Greater extent of&#44; and even excessive&#44; LV trabeculation measured in end-diastole in asymptomatic population-representative individuals appeared benign and was not associated with deterioration in LV volumes or Function during an almost 10-year period&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">O mioc&#225;rdio n&#227;o compactado &#40;MNC&#41; &#233; uma miocardiopatia relativamente rara&#44; com uma preval&#234;ncia estimada em 0&#44;014-0&#44;17&#37;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; caracterizada pela presen&#231;a de trabecula&#231;&#245;es proeminentes do mioc&#225;rdio ventricular esquerdo&#44; com recessos profundos em comunica&#231;&#227;o com a cavidade&#44; redundando em uma apar&#234;ncia esponjosa&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Estruturalmente&#44; observam-se duas camadas na parede ventricular&#44; uma interna n&#227;o-compactada e uma externa&#44; subepic&#225;rdica&#44; compactada&#44; com caracter&#237;sticas macrosc&#243;picas mais pr&#243;ximas do mioc&#225;rdio normal&#46; Esta miocardiopatia pode ser assintom&#225;tica e n&#227;o se associar a complica&#231;&#245;es ou acompanhar-se de depress&#227;o da fun&#231;&#227;o sist&#243;lica e diast&#243;lica&#44; insufici&#234;ncia card&#237;aca&#44; arritmias supraventriculares e ventriculares&#44; perturba&#231;&#245;es da condu&#231;&#227;o ou fen&#243;menos trombo-emb&#243;licos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Descrita pela primeira vez h&#225; 25 anos<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#44; permanece ainda enigm&#225;tica e controversa&#46; Tem sido classificada pela Sociedade Europeia de Cardiologia como uma &#171;miocardiopatia n&#227;o classificada&#187; e pela <span class="elsevierStyleItalic">American Heart Association</span> como uma miocardiopatia gen&#233;tica&#44; sendo proposto como mecanismo causal a paragem da normal compacta&#231;&#227;o ventricular durante a embriog&#233;nese<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Est&#227;o descritos fen&#243;tipos de MNC em associa&#231;&#227;o a doen&#231;as neuromusculares&#44; assim como a cardiopatias cong&#233;nitas&#44; sobretudo as que apresentam malforma&#231;&#245;es com obst&#225;culos ventriculares<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Contudo&#44; a forma comum de MNC isolada permanece um desafio no que respeita ao mecanismo subjacente e &#224;s apresenta&#231;&#245;es cl&#237;nicas&#44; pois surge quer na inf&#226;ncia quer no adulto quer em formas heredo-familiares&#44; estando nestes casos identificadas diferentes muta&#231;&#245;es que codificam prote&#237;nas sarcom&#233;ricas&#44; do citosqueleto ou da membrana nuclear<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Uma das &#225;reas de maior desafio relaciona-se com o seu diagn&#243;stico&#46; O m&#233;todo de imagem mais acess&#237;vel &#233; a ecocardiografia&#44; mas a resson&#226;ncia magn&#233;tica card&#237;aca &#40;RMC&#41;&#44; devido &#224; sua maior resolu&#231;&#227;o espacial e aus&#234;ncia de limita&#231;&#245;es de janela &#40;nomeadamente na &#225;rea apical&#41;&#44; apresenta maior acuidade diagn&#243;stica&#44; sendo uma modalidade de refer&#234;ncia quando permanecem d&#250;vidas pela ultrassonografia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">T&#234;m sido propostos v&#225;rios crit&#233;rios diagn&#243;sticos com base nos m&#233;todos de imagem&#44; que utilizam o estudo do n&#250;mero de trab&#233;culas com origem na regi&#227;o apical distal aos m&#250;sculos papilares<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; a raz&#227;o entre a espessura da camada n&#227;o compactada e a compactada<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; ou a raz&#227;o entre a massa n&#227;o compactada e a massa ventricular<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; sendo&#44; contudo&#44; estes crit&#233;rios derivados de pequenas popula&#231;&#245;es e n&#227;o validados prospetivamente&#44; havendo tamb&#233;m concord&#226;ncia limitada entre os v&#225;rios crit&#233;rios&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O avan&#231;o das t&#233;cnicas de imagem nos &#250;ltimos anos&#44; nomeadamente a utiliza&#231;&#227;o crescente da RMC&#44; tem revelado a presen&#231;a de trabecula&#231;&#245;es ventriculares expressivas&#44; e frequentemente preenchendo os crit&#233;rios de imagem propostos para o MNC&#44; em indiv&#237;duos sem doen&#231;a aparente&#44; conduzindo a estrat&#233;gias de reavalia&#231;&#227;o sistem&#225;tica dos indiv&#237;duos e seus familiares ao longo do tempo&#44; com o objetivo de detetar atempada e precocemente o desenvolvimento de poss&#237;veis manifesta&#231;&#245;es patol&#243;gicas ou sinais evidentes de risco&#58; estes casos s&#227;o assim considerados como em fase de miocardiopatia pr&#233;-cl&#237;nica&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O presente subestudo do estudo <span class="elsevierStyleItalic">Multi-Ethnic Study of Atherosclerosis</span> &#40;MESA&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; que incluiu 2742 indiv&#237;duos adultos&#44; sem doen&#231;a card&#237;aca e estudados sistematicamente por RMC&#44; utilizando os crit&#233;rios de Peterson et al&#46; para MNC&#44; permitiu identificar em 25&#37; dos indiv&#237;duos um crit&#233;rio de MNC presente em &#8805;<span class="elsevierStyleHsp" style=""></span>1 segmento e 8&#37; de indiv&#237;duos com n&#227;o-compacta&#231;&#227;o em &#8805;<span class="elsevierStyleHsp" style=""></span>2 segmentos&#46; Ao longo de 9&#44;5 anos de seguimento&#44; verificou-se ligeiro aumento das dimens&#245;es ventriculares e discreta redu&#231;&#227;o da fra&#231;&#227;o de eje&#231;&#227;o&#44; n&#227;o havendo diferen&#231;as entre os quintis relativos &#224; extens&#227;o da n&#227;o-compacta&#231;&#227;o&#46; O n&#250;mero de eventos durante o longo per&#237;odo de seguimento foi reduzido &#40;cerca de 4&#37;&#41;&#44; traduzindo uma evolu&#231;&#227;o benigna&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este estudo imp&#245;e importantes reflex&#245;es e ila&#231;&#245;es&#46; No que diz respeito &#224; validade dos crit&#233;rios utilizados&#44; a simplicidade e a reprodutibilidade do crit&#233;rio proposto por Petersen et al<span class="elsevierStyleItalic">&#46;</span> para o diagn&#243;stico por RMC levam &#224; sua ampla aplica&#231;&#227;o na cl&#237;nica&#44; sem contudo se poder deixar de considerar o eventual valor de outros m&#233;todos potencialmente mais espec&#237;ficos&#46; A an&#225;lise da probabilidade pr&#233;-teste de miocardiopatia&#44; proposta pelos autores &#40;tendo em considera&#231;&#227;o a presen&#231;a de hist&#243;ria familiar ou de manifesta&#231;&#245;es cardiovasculares&#41;&#44; ser&#225; certamente uma orienta&#231;&#227;o &#250;til na estrat&#233;gia do diagn&#243;stico&#46; As consequ&#234;ncias imediatas desta estrat&#233;gia seriam assim a suspens&#227;o de atitudes diagn&#243;sticas ou terap&#234;uticas adicionais em indiv&#237;duos com o fen&#243;tipo de MNC assintom&#225;ticos&#44; sem manifesta&#231;&#245;es cardiovasculares e sem hist&#243;ria familiar&#46; Contudo&#44; s&#227;o necess&#225;rios estudos adicionais prospetivos que permitam identificar as vari&#225;veis cl&#237;nicas&#44; de imagem &#40;obtidas possivelmente de multimodalidade&#41; e gen&#233;ticas&#44; suscet&#237;veis de permitirem criar algoritmos diagn&#243;sticos com mais elevada acuidade diagnostica&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">&#201; poss&#237;vel que outros avan&#231;os possam fornecer dados adicionais com utilidade acrescida&#46; De referir&#44; nomeadamente&#44; a recente t&#233;cnica matem&#225;tica representada pela an&#225;lise fractal&#44; dirigida ao estudo de trabecula&#231;&#245;es complexas&#44; permitindo o diagn&#243;stico imagiol&#243;gico de MNC com elevada precis&#227;o<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></span></span>"
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Comment on “The relationship of left ventricular trabeculation to ventricular function and structure over a 9.5 year follow-up. The MESA study“
Comentário a «A relação da trabeculação ventricular esquerda com a função e estrutura do ventrículo num período de seguimento superior a 9,5 anos. O estudo MESA»
Ana G. Almeida
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anagalmeida@gmail.com

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Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia
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    "titulo" => "Comment on &#8220;The relationship of left ventricular trabeculation to ventricular function and structure over a 9&#46;5 year follow-up&#46; The MESA study&#8220;"
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        "titulo" => "Coment&#225;rio a &#171;A rela&#231;&#227;o da trabecula&#231;&#227;o ventricular esquerda com a fun&#231;&#227;o e estrutura do ventr&#237;culo num per&#237;odo de seguimento superior a 9&#44;5 anos&#46; O estudo MESA&#187;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0015" class="elsevierStylePara elsevierViewall">BACKGROUND Left ventricular &#40;LV&#41; trabeculation is highly variable among individuals and is increased in some diseases &#40;e&#46;g&#46;&#44; congenital heart disease or cardiomyopathies&#41;&#44; but its significance in population-representative individuals is unknown&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">OBJECTIVES The goal of this study was to determine if excessive LV trabeculation in population-representative individuals is associated with preceding changes in cardiac volumes and function&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">METHODS For technical reasons&#44; the extent of trabeculation&#44; which is expressed as the ratio of noncompacted to compacted &#40;NC&#47;<span class="elsevierStyleSmallCaps">C</span>&#41; myocardium&#44; was measured on cardiac magnetic resonance &#40;CMR&#41; long-axis cine images in 2&#44;742 participants in the MESA &#40;Multi-Ethnic Study of Atherosclerosis&#41; &#40;mean age 68&#46;7 years&#59; 52&#46;3&#37; women&#59; 56&#46;4&#37; with hypertension&#59; 16&#46;8&#37; with diabetes&#41; at examination 5&#46; These were considered in quintiles of trabeculation extent&#59; the NC&#47;C ratio of quintile 5 was 2&#46;46 to 5&#46;41&#46; We determined the relationship between the maximal NC&#47;C ratio and the preceding change &#40;9&#46;5 years between examinations 1 and 5&#41; in end-systolic volume indexed &#40;ESVi&#41; to body surface area&#46; Secondary analyses assessed the associations between the maximal NC&#47;C ratio and preceding changes in end-diastolic volume indexed &#40;EDVi&#41; to body surface area and the ejection fraction &#40;EF&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">RESULTS Over 9&#46;5 years&#44; the ESVi decreased by 1&#46;3<span class="elsevierStyleHsp" style=""></span>ml&#47;m2&#44; the EDVi decreased by 5&#46;1<span class="elsevierStyleHsp" style=""></span>ml&#47;m2&#44; and the EF decreased by 0&#46;6&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Even in subjects with excessive trabeculation&#44; there were no clinically relevant differences in LV volumes and systolic function changes among the quintiles of trabeculation extent&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">CONCLUSIONS Greater extent of&#44; and even excessive&#44; LV trabeculation measured in end-diastole in asymptomatic population-representative individuals appeared benign and was not associated with deterioration in LV volumes or Function during an almost 10-year period&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">O mioc&#225;rdio n&#227;o compactado &#40;MNC&#41; &#233; uma miocardiopatia relativamente rara&#44; com uma preval&#234;ncia estimada em 0&#44;014-0&#44;17&#37;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; caracterizada pela presen&#231;a de trabecula&#231;&#245;es proeminentes do mioc&#225;rdio ventricular esquerdo&#44; com recessos profundos em comunica&#231;&#227;o com a cavidade&#44; redundando em uma apar&#234;ncia esponjosa&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Estruturalmente&#44; observam-se duas camadas na parede ventricular&#44; uma interna n&#227;o-compactada e uma externa&#44; subepic&#225;rdica&#44; compactada&#44; com caracter&#237;sticas macrosc&#243;picas mais pr&#243;ximas do mioc&#225;rdio normal&#46; Esta miocardiopatia pode ser assintom&#225;tica e n&#227;o se associar a complica&#231;&#245;es ou acompanhar-se de depress&#227;o da fun&#231;&#227;o sist&#243;lica e diast&#243;lica&#44; insufici&#234;ncia card&#237;aca&#44; arritmias supraventriculares e ventriculares&#44; perturba&#231;&#245;es da condu&#231;&#227;o ou fen&#243;menos trombo-emb&#243;licos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Descrita pela primeira vez h&#225; 25 anos<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#44; permanece ainda enigm&#225;tica e controversa&#46; Tem sido classificada pela Sociedade Europeia de Cardiologia como uma &#171;miocardiopatia n&#227;o classificada&#187; e pela <span class="elsevierStyleItalic">American Heart Association</span> como uma miocardiopatia gen&#233;tica&#44; sendo proposto como mecanismo causal a paragem da normal compacta&#231;&#227;o ventricular durante a embriog&#233;nese<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Est&#227;o descritos fen&#243;tipos de MNC em associa&#231;&#227;o a doen&#231;as neuromusculares&#44; assim como a cardiopatias cong&#233;nitas&#44; sobretudo as que apresentam malforma&#231;&#245;es com obst&#225;culos ventriculares<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Contudo&#44; a forma comum de MNC isolada permanece um desafio no que respeita ao mecanismo subjacente e &#224;s apresenta&#231;&#245;es cl&#237;nicas&#44; pois surge quer na inf&#226;ncia quer no adulto quer em formas heredo-familiares&#44; estando nestes casos identificadas diferentes muta&#231;&#245;es que codificam prote&#237;nas sarcom&#233;ricas&#44; do citosqueleto ou da membrana nuclear<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Uma das &#225;reas de maior desafio relaciona-se com o seu diagn&#243;stico&#46; O m&#233;todo de imagem mais acess&#237;vel &#233; a ecocardiografia&#44; mas a resson&#226;ncia magn&#233;tica card&#237;aca &#40;RMC&#41;&#44; devido &#224; sua maior resolu&#231;&#227;o espacial e aus&#234;ncia de limita&#231;&#245;es de janela &#40;nomeadamente na &#225;rea apical&#41;&#44; apresenta maior acuidade diagn&#243;stica&#44; sendo uma modalidade de refer&#234;ncia quando permanecem d&#250;vidas pela ultrassonografia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">T&#234;m sido propostos v&#225;rios crit&#233;rios diagn&#243;sticos com base nos m&#233;todos de imagem&#44; que utilizam o estudo do n&#250;mero de trab&#233;culas com origem na regi&#227;o apical distal aos m&#250;sculos papilares<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; a raz&#227;o entre a espessura da camada n&#227;o compactada e a compactada<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; ou a raz&#227;o entre a massa n&#227;o compactada e a massa ventricular<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; sendo&#44; contudo&#44; estes crit&#233;rios derivados de pequenas popula&#231;&#245;es e n&#227;o validados prospetivamente&#44; havendo tamb&#233;m concord&#226;ncia limitada entre os v&#225;rios crit&#233;rios&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O avan&#231;o das t&#233;cnicas de imagem nos &#250;ltimos anos&#44; nomeadamente a utiliza&#231;&#227;o crescente da RMC&#44; tem revelado a presen&#231;a de trabecula&#231;&#245;es ventriculares expressivas&#44; e frequentemente preenchendo os crit&#233;rios de imagem propostos para o MNC&#44; em indiv&#237;duos sem doen&#231;a aparente&#44; conduzindo a estrat&#233;gias de reavalia&#231;&#227;o sistem&#225;tica dos indiv&#237;duos e seus familiares ao longo do tempo&#44; com o objetivo de detetar atempada e precocemente o desenvolvimento de poss&#237;veis manifesta&#231;&#245;es patol&#243;gicas ou sinais evidentes de risco&#58; estes casos s&#227;o assim considerados como em fase de miocardiopatia pr&#233;-cl&#237;nica&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O presente subestudo do estudo <span class="elsevierStyleItalic">Multi-Ethnic Study of Atherosclerosis</span> &#40;MESA&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; que incluiu 2742 indiv&#237;duos adultos&#44; sem doen&#231;a card&#237;aca e estudados sistematicamente por RMC&#44; utilizando os crit&#233;rios de Peterson et al&#46; para MNC&#44; permitiu identificar em 25&#37; dos indiv&#237;duos um crit&#233;rio de MNC presente em &#8805;<span class="elsevierStyleHsp" style=""></span>1 segmento e 8&#37; de indiv&#237;duos com n&#227;o-compacta&#231;&#227;o em &#8805;<span class="elsevierStyleHsp" style=""></span>2 segmentos&#46; Ao longo de 9&#44;5 anos de seguimento&#44; verificou-se ligeiro aumento das dimens&#245;es ventriculares e discreta redu&#231;&#227;o da fra&#231;&#227;o de eje&#231;&#227;o&#44; n&#227;o havendo diferen&#231;as entre os quintis relativos &#224; extens&#227;o da n&#227;o-compacta&#231;&#227;o&#46; O n&#250;mero de eventos durante o longo per&#237;odo de seguimento foi reduzido &#40;cerca de 4&#37;&#41;&#44; traduzindo uma evolu&#231;&#227;o benigna&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este estudo imp&#245;e importantes reflex&#245;es e ila&#231;&#245;es&#46; No que diz respeito &#224; validade dos crit&#233;rios utilizados&#44; a simplicidade e a reprodutibilidade do crit&#233;rio proposto por Petersen et al<span class="elsevierStyleItalic">&#46;</span> para o diagn&#243;stico por RMC levam &#224; sua ampla aplica&#231;&#227;o na cl&#237;nica&#44; sem contudo se poder deixar de considerar o eventual valor de outros m&#233;todos potencialmente mais espec&#237;ficos&#46; A an&#225;lise da probabilidade pr&#233;-teste de miocardiopatia&#44; proposta pelos autores &#40;tendo em considera&#231;&#227;o a presen&#231;a de hist&#243;ria familiar ou de manifesta&#231;&#245;es cardiovasculares&#41;&#44; ser&#225; certamente uma orienta&#231;&#227;o &#250;til na estrat&#233;gia do diagn&#243;stico&#46; As consequ&#234;ncias imediatas desta estrat&#233;gia seriam assim a suspens&#227;o de atitudes diagn&#243;sticas ou terap&#234;uticas adicionais em indiv&#237;duos com o fen&#243;tipo de MNC assintom&#225;ticos&#44; sem manifesta&#231;&#245;es cardiovasculares e sem hist&#243;ria familiar&#46; Contudo&#44; s&#227;o necess&#225;rios estudos adicionais prospetivos que permitam identificar as vari&#225;veis cl&#237;nicas&#44; de imagem &#40;obtidas possivelmente de multimodalidade&#41; e gen&#233;ticas&#44; suscet&#237;veis de permitirem criar algoritmos diagn&#243;sticos com mais elevada acuidade diagnostica&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">&#201; poss&#237;vel que outros avan&#231;os possam fornecer dados adicionais com utilidade acrescida&#46; De referir&#44; nomeadamente&#44; a recente t&#233;cnica matem&#225;tica representada pela an&#225;lise fractal&#44; dirigida ao estudo de trabecula&#231;&#245;es complexas&#44; permitindo o diagn&#243;stico imagiol&#243;gico de MNC com elevada precis&#227;o<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></span></span>"
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Revista Portuguesa de Cardiologia (English edition)
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