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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o cl&#237;nica do doente com suspeita de doen&#231;a coron&#225;ria est&#225;vel &#40;DC&#41; &#233; frequentemente complementada por exames n&#227;o invasivos&#46; A prova de esfor&#231;o &#40;PE&#41; &#233; habitualmente o exame de primeira linha neste contexto<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; secundada por outros testes funcionais&#44; como o ecocardiograma de sobrecarga &#40;ES&#41; e a cintigrafia de perfus&#227;o mioc&#225;rdica &#40;CPM&#41;&#46; Nos &#250;ltimos anos&#44; a angio-TC card&#237;aca tem ganho crescente aceita&#231;&#227;o&#44; sendo uma alternativa v&#225;lida em doentes com probabilidade pr&#233;-teste interm&#233;dia ou baixa<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> e &#233; j&#225;&#44; em alguns casos&#44; o primeiro exame solicitado&#46; A rentabilidade de qualquer teste diagn&#243;stico depende da probabilidade pr&#233;-teste dos doentes em quem &#233; usado e da forma como o teste modifica essa probabilidade&#44; idealmente aumentando-a para um n&#237;vel que justifique a realiza&#231;&#227;o de angiografia coron&#225;ria invasiva &#40;ACI&#41;&#44; ou reduzindo-a para valores que permitam a exclus&#227;o do diagn&#243;stico&#46; O objetivo deste estudo foi avaliar a evolu&#231;&#227;o da probabilidade te&#243;rica de DC obstrutiva em doentes que efetuaram angio-TC card&#237;aca como exame de primeira linha <span class="elsevierStyleItalic">versus</span> doentes que realizaram angio-TC ap&#243;s PE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Num registo prospetivo de 575 doentes que realizaram angio-TC card&#237;aca no Hospital dos Lus&#237;adas entre janeiro de 2009 e abril de 2011&#44; selecion&#225;mos os doentes cuja indica&#231;&#227;o para o exame foi a suspeita cl&#237;nica de DC&#46; Exclu&#237;ram-se os indiv&#237;duos assintom&#225;ticos e os doentes com DC documentada&#44; nomeadamente aqueles com antecedentes de s&#237;ndrome coron&#225;ria aguda&#44; revasculariza&#231;&#227;o mioc&#225;rdica ou estenose coron&#225;ria superior ou igual a 50&#37; previamente diagnosticada em ACI&#46; Os doentes referenciados ap&#243;s terem realizado testes imagiol&#243;gicos de isqu&#233;mia mioc&#225;rdica&#44; nomeadamente CPM ou ES&#44; foram tamb&#233;m exclu&#237;dos&#46; Os 292 doentes inclu&#237;dos na an&#225;lise foram divididos em 2 grupos&#44; de acordo com a marcha diagn&#243;stica realizada&#58; um que realizou angio-TC coron&#225;ria como exame de primeira linha &#40;grupo A&#41; e outro que realizou PE seguida de angio-TC coron&#225;ria &#40;grupo B&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Probabilidade pr&#233;-teste</span><p id="par0015" class="elsevierStylePara elsevierViewall">A probabilidade pr&#233;-teste de DC obstrutiva foi determinada para cada um dos doentes utilizando o modelo preditivo de Genders et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; que vem atualizar e complementar o anterior modelo de Diamond e Forrester<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; As vari&#225;veis-exposi&#231;&#227;o consideradas no atual modelo s&#227;o a idade&#44; o sexo e a sintomatologia &#40;categorizada em angina t&#237;pica&#44; angina at&#237;pica ou dor tor&#225;cica n&#227;o anginosa&#41;&#46; A fun&#231;&#227;o probabilidade&#44; estimada pelo modelo de regress&#227;o log&#237;stica desenvolvido&#44; &#233; dada pela express&#227;o f&#40;z&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#47;&#40;1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>e<span class="elsevierStyleSup">&#8722;z</span>&#41;&#44; em que z representa a contribui&#231;&#227;o de cada uma das vari&#225;veis-exposi&#231;&#227;o e &#233; igual a &#8722;4&#44;37<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;04<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>idade &#40;em anos&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1&#44;34 &#40;se indiv&#237;duo do sexo masculino&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1&#44;9 se angina t&#237;pica ou 0&#44;64 se angina at&#237;pica&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prova de esfor&#231;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Os doentes do grupo B realizaram a angio-TC coron&#225;ria na sequ&#234;ncia de uma PE efetuada nos 6 meses pr&#233;vios&#46; As PE foram realizadas e interpretadas pelos respetivos m&#233;dicos assistentes e categorizadas como positivas&#44; negativas&#44; inconclusivas ou duvidosas&#44; de acordo com a informa&#231;&#227;o constante nos relat&#243;rios de que os doentes eram portadores e&#47;ou da informa&#231;&#227;o cl&#237;nica presente no pedido da angio-TC&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Angio-TC coron&#225;ria</span><p id="par0025" class="elsevierStylePara elsevierViewall">Todos os doentes realizaram angio-TC coron&#225;ria num aparelho de 64 cortes de dupla ampola &#40;Siemens Somatom Definition<span class="elsevierStyleSup">&#174;</span>&#44; Forchheim&#44; Alemanha&#41;&#44; ap&#243;s administra&#231;&#227;o de 5<span class="elsevierStyleHsp" style=""></span>mg de nitroglicerina sublingual&#46; Foram administrados bloqueadores beta em 72&#37; dos casos e foi usado um protocolo de aquisi&#231;&#227;o prospetiva em 44&#37; dos doentes&#46; A mediana da dose total de radia&#231;&#227;o foi de 280<span class="elsevierStyleHsp" style=""></span>mGy&#46;cm &#91;171-577&#93;&#46; Imediatamente antes da angio-TC&#44; foi sistematicamente efetuada uma aquisi&#231;&#227;o sem contraste para c&#225;lculo do <span class="elsevierStyleItalic">score</span> de c&#225;lcio de Agatston&#46; A decis&#227;o de inclus&#227;o de doentes com <span class="elsevierStyleItalic">scores</span> superiores a 400 foi efetuada caso a caso&#44; uma vez que&#44; na nossa institui&#231;&#227;o&#44; essa &#233; considerada uma contraindica&#231;&#227;o relativa para realiza&#231;&#227;o de angio-TC&#46; As imagens da angio-TC foram processadas e avaliadas numa esta&#231;&#227;o de trabalho de imagem tridimensional &#40;Terarecon<span class="elsevierStyleSup">&#174;</span>&#44; California&#44; EUA&#41;&#44; utilizando reformata&#231;&#245;es multiplanares&#44; proje&#231;&#245;es de intensidade m&#225;xima e cortes seccionais dos vasos&#44; conforme apropriado&#46; Definiu-se DC anatomicamente obstrutiva como a presen&#231;a de pelo menos uma estenose luminal &#8805;<span class="elsevierStyleHsp" style=""></span>50&#37; num vaso epic&#225;rdico&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Probabilidade p&#243;s-teste</span><p id="par0030" class="elsevierStylePara elsevierViewall">A probabilidade p&#243;s-teste para cada doente foi calculada recorrendo ao teorema de Bayes&#44; segundo a equa&#231;&#227;o&#58; P&#40;A&#124;B&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#91;P&#40;B&#124;A&#41;<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>P&#40;A&#41;&#93;&#47;P&#40;B&#41;&#44; em que P&#40;A&#124;B&#41; &#233; a probabilidade p&#243;s-teste condicionada pela probabilidade pr&#233;-teste &#91;P&#40;A&#41;&#93; e P&#40;B&#41; a probabilidade determinada pelo teste usado<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Assumiu-se uma sensibilidade de 98&#37; e uma especificidade de 85&#37; para a angio-TC coron&#225;ria de acordo os resultados da mais recente meta-an&#225;lise publicada<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Para a prova de esfor&#231;o&#44; assumiram-se valores de sensibilidade e especificidade de 68 e de 77&#37;&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nos doentes com PE inconclusiva&#44; a probabilidade p&#243;s-teste atribu&#237;da foi id&#234;ntica &#224; probabilidade pr&#233;-teste estimada como anteriormente descrito&#46; De igual modo&#44; nos doentes em que a angio-TC n&#227;o demonstrou a presen&#231;a de placas obstrutivas mas em que um ou mais segmentos n&#227;o foram avali&#225;veis devido &#224; presen&#231;a de artefactos&#44; atribuiu-se uma probabilidade p&#243;s-teste igual &#224; probabilidade pr&#233;-teste&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lise estat&#237;stica</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os grupos foram comparados com recurso aos testes de T-Student ou Mann<span class="elsevierStyleItalic">-</span>Witney para as vari&#225;veis cont&#237;nuas e ao teste exato de Fisher para as vari&#225;veis categ&#243;ricas&#46; Os valores das vari&#225;veis cont&#237;nuas com distribui&#231;&#227;o sim&#233;trica e assim&#233;trica apresentam-se em m&#233;dia &#40;&#177;<span class="elsevierStyleHsp" style=""></span>desvio-padr&#227;o&#41; e mediana &#91;intervalo interquartil&#93;&#44; respetivamente&#46; A an&#225;lise estat&#237;stica foi efetuada com o <span class="elsevierStyleItalic">software</span> SPSS Statistics v17&#46;0 for Windows&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">N&#227;o se verificaram diferen&#231;as estatisticamente significativas no que diz respeito &#224;s vari&#225;veis demogr&#225;ficas&#44; apresenta&#231;&#227;o cl&#237;nica ou perfil de risco cardiovascular &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#44; &#224; exce&#231;&#227;o da diabetes&#44; que foi mais frequente no grupo B &#40;20 <span class="elsevierStyleItalic">versus</span> 10&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; e dos antecedentes familiares de doen&#231;a coron&#225;ria precoce&#44; que foram mais frequentes no grupo A &#40;19 <span class="elsevierStyleItalic">versus</span> 11&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;050&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A mediana do <span class="elsevierStyleItalic">score</span> de c&#225;lcio de Agatston foi de 0&#44;8 &#91;0&#44;0-93&#44;5&#93;&#44; com apenas 6&#37; dos doentes a apresentarem <span class="elsevierStyleItalic">scores</span> superiores a 400&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A mediana da probabilidade pr&#233;-teste de doen&#231;a coron&#225;ria obstrutiva foi de 23&#37; &#91;13-36&#93; e n&#227;o diferiu significativamente entre os dois grupos de estudo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;479&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dos 134 doentes que realizaram PE&#44; 68 &#40;51&#37;&#41; tiveram um teste positivo&#44; 60 dos quais exclusivamente por crit&#233;rios eletrocardiogr&#225;ficos&#44; 6 por angor durante a prova e 2 por angor associado a altera&#231;&#245;es eletrocardiogr&#225;ficas&#46; Em 36 doentes &#40;27&#37;&#41;&#44; a PE foi classificada como negativa para isquemia mioc&#225;rdica&#46; A PE foi considerada duvidosa em 10 doentes &#40;7&#37;&#41; e inconclusiva em 20 doentes &#40;15&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dezanove &#40;12&#37;&#41; doentes do grupo A e 26 &#40;19&#37;&#41; doentes do grupo B apresentaram doen&#231;a coron&#225;ria obstrutiva na angio-TC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;082&#41;&#46; As caracter&#237;sticas angiogr&#225;ficas dos doentes estudados est&#227;o expressas na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46; No grupo B&#44; a percentagem de doentes que apresentavam DC obstrutiva na angio-TC foi de 22&#37; entre aqueles com PE positiva&#44; e de 14&#37; nos indiv&#237;duos com PE negativa&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A probabilidade te&#243;rica de DC em cada etapa diagn&#243;stica dos grupos A e B encontra-se expressa na <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#46; A evolu&#231;&#227;o da probabilidade te&#243;rica individual de DC obstrutiva ao longo de sequ&#234;ncia diagn&#243;stica utilizada em cada um dos grupos est&#225; representada na <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Quando se categorizou a probabilidade de DC em muito baixa &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5&#37;&#41;&#44; baixa &#40;5-9&#37;&#41;&#44; interm&#233;dia &#40;10-90&#37;&#41; e elevada &#40;&#62;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41;&#44; verificou-se que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">no grupo A&#44; 84&#37; &#40;119&#47;142&#41; dos doentes com probabilidade inicial interm&#233;dia foram reclassificados noutras categorias&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">no grupo B&#44; ap&#243;s a prova de esfor&#231;o&#44; apenas 13&#37; &#40;17&#47;127&#41; dos doentes com probabilidade interm&#233;dia foram reclassificados noutras categorias&#44; sendo que 15 doentes desceram para a categoria de baixa probabilidade e dois doentes para muito baixa probabilidade&#46; Quando se aplicou a angio-TC neste grupo&#44; 82&#37; &#40;94&#47;115&#41; dos doentes com probabilidade interm&#233;dia ap&#243;s PE foram reclassificados &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figuras 2 e 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">A abordagem de um doente com suspeita de doen&#231;a coron&#225;ria envolve invariavelmente uma estimativa &#40;qualitativa ou quantitativa&#41; da probabilidade pr&#233;-teste desse indiv&#237;duo&#44; que o cl&#237;nico efetua com base na sintomatologia e fatores de risco cardiovascular&#46; As atuais normas de orienta&#231;&#227;o cl&#237;nica recomendam que os doentes com probabilidade elevada sejam referenciados diretamente para ACI&#44; ao contr&#225;rio dos doentes com probabilidade interm&#233;dia&#44; em quem est&#225; indicada a realiza&#231;&#227;o de testes n&#227;o-invasivos<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; &#192; luz do teorema de Bayes&#44; estes exames atuam como verdadeiros modificadores da probabilidade de doen&#231;a coron&#225;ria&#46; Idealmente&#44; dever&#227;o aument&#225;-la para um n&#237;vel que justifique a realiza&#231;&#227;o de ACI&#44; ou reduzi-la para valores que permitam a exclus&#227;o do diagn&#243;stico&#46; Partindo dos valores de sensibilidade e especificidade da PE e da angio-TC publicados em meta-an&#225;lises&#44; procur&#225;mos avaliar a evolu&#231;&#227;o da probabilidade te&#243;rica de DC obstrutiva quando estes exames s&#227;o aplicados a doentes concretos&#46; &#201; importante compreender que este n&#227;o &#233; um estudo de acuidade diagn&#243;stica e que&#44; dada a aus&#234;ncia de <span class="elsevierStyleItalic">gold standard</span>&#44; n&#227;o se pode assumir que um exame esteja correto em detrimento do outro&#44; nomeadamente quando os seus resultados s&#227;o discordantes&#46; N&#227;o obstante&#44; os resultados desta an&#225;lise sugerem que a angio-TC card&#237;aca permite reclassificar a grande maioria dos doentes com probabilidade interm&#233;dia em categorias de risco inferior ou superior&#44; ao passo que a PE apenas permite reclassificar o risco numa pequena propor&#231;&#227;o destes doentes&#44; mantendo-os maioritariamente em n&#237;veis de risco interm&#233;dios&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">&#201; interessante notar que o n&#250;mero de angio-TC solicitadas como exame de primeira linha &#233;&#44; na nossa casu&#237;stica&#44; ligeiramente superior ao n&#250;mero de angio-TC requisitadas na sequ&#234;ncia de uma PE&#44; e que&#44; neste &#250;ltimo caso&#44; a referencia&#231;&#227;o acontece tanto em casos de PE positiva como de PE negativa&#46; &#201; tamb&#233;m de real&#231;ar que a probabilidade pr&#233;-teste foi relativamente baixa em ambos os grupos&#44; sugerindo um uso globalmente adequado da angio-TC por parte dos m&#233;dicos referenciadores&#46; Por outro lado&#44; a preval&#234;ncia de DC obstrutiva por angio-TC foi ligeiramente inferior ao estimado pela probabilidade pr&#233;-teste&#44; o que est&#225; em linha com dados recentes que sugerem que os m&#233;todos cl&#237;nicos tendem a sobrestimar essa preval&#234;ncia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A escolha de uma ou de outra t&#233;cnica como exame de primeira linha dever&#225; ter por base as suas vantagens e desvantagens relativas&#44; nomeadamente em termos de acuidade diagn&#243;stica&#44; acessibilidade&#44; custos e contraindica&#231;&#245;es&#46; A PE &#233; um exame acess&#237;vel e com custos diretos baixos&#44; fatores que fazem dela o teste n&#227;o invasivo mais frequentemente requisitado nos doentes com suspeita de doen&#231;a coron&#225;ria&#46; No entanto&#44; as suas limita&#231;&#245;es de sensibilidade e especificidade tornam o seu desempenho sub&#243;timo em muitos casos<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; com potenciais repercuss&#245;es em termos de custos indiretos&#46; As provas inconclusivas conduzem geralmente a exames adicionais&#44; que aumentam o custo global da estrat&#233;gia diagn&#243;stica&#59; os resultados falsos negativos poder&#227;o atrasar ou impedir o diagn&#243;stico adequado&#59; e os resultados falsos positivos motivam frequentemente a realiza&#231;&#227;o de exames n&#227;o invasivos mais complexos e onerosos ou de cateterismos diagn&#243;sticos desnecess&#225;rios&#44; que acarretam riscos e custos potencialmente evit&#225;veis&#46; A dimens&#227;o deste &#250;ltimo problema &#233; ilustrada pelos resultados de um grande registo norte-americano&#44; em que 62&#37; dos 398 978 indiv&#237;duos referenciados para ACI diagn&#243;stica n&#227;o apresentavam DC obstrutiva<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Em Portugal&#44; dados recentes apresentados por um centro de grande volume mostraram que 43&#37; dos 1892 doentes submetidos a coronariografia diagn&#243;stica por suspeita de DC num per&#237;odo de cerca de 5 anos n&#227;o apresentavam DC obstrutiva&#46; Destes&#44; cerca de dois quintos haviam sido referenciados por prova de esfor&#231;o positiva<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Uma maior implementa&#231;&#227;o da angio-TC card&#237;aca&#44; se usada adequadamente&#44; poder&#225; contribuir para minorar este problema&#44; j&#225; que a angio-TC parece ter um impacto positivo na redu&#231;&#227;o do n&#250;mero de coronariografias normais<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Uma potencial vantagem da PE &#233; a sua capacidade de fornecer informa&#231;&#227;o acerca da capacidade funcional do doente&#44; dado com reconhecida import&#226;ncia progn&#243;stica<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; A angio-TC&#44; contudo&#44; tamb&#233;m fornece informa&#231;&#227;o progn&#243;stica&#44; permitindo mesmo a dete&#231;&#227;o de DC n&#227;o obstrutiva&#44; que n&#227;o &#233; avaliada por testes funcionais como a PE<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Um estudo comparativo direto recente sugere que a angio-TC tenha um valor progn&#243;stico superior e incremental ao da PE<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A angio-TC card&#237;aca tamb&#233;m n&#227;o &#233; uma t&#233;cnica isenta de inconvenientes e limita&#231;&#245;es&#46; A sua menor acessibilidade&#44; maior custo direto e emprego de radia&#231;&#227;o ionizante e contraste iodado limitam o seu uso na pr&#225;tica cl&#237;nica&#46; A quest&#227;o do custo-efic&#225;cia&#44; em particular&#44; tem sido objeto de investiga&#231;&#227;o e an&#225;lise&#46; Quando comparada com os testes funcionais habitualmente empregues &#40;PE&#44; ES&#44; CPM&#41;&#44; a angio-TC tem-se mostrado uma t&#233;cnica custo-eficaz<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; sobretudo quando a probabilidade pr&#233;-teste &#233; &#8804;<span class="elsevierStyleHsp" style=""></span>50&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; &#201; igualmente importante relembrar que uma percentagem n&#227;o desprez&#237;vel dos doentes submetidos a angio-TC &#40;nomeadamente&#44; aqueles com estenoses de grau interm&#233;dio&#41; necessitar&#225; de testes de isquemia subsequentes&#44; se queremos evitar coronariografias e angioplastias desnecess&#225;rias&#46; &#201; poss&#237;vel que&#44; num futuro pr&#243;ximo&#44; a angio-TC permita tamb&#233;m a avalia&#231;&#227;o de isquemia por t&#233;cnicas de perfus&#227;o<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> ou de reserva de fluxo coron&#225;rio virtual<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; mas essa ainda n&#227;o &#233; uma aplica&#231;&#227;o estabelecida&#46; Em rela&#231;&#227;o &#224;s restantes limita&#231;&#245;es&#44; cabe dizer que a disponibilidade da t&#233;cnica tem aumentado substancialmente no &#250;ltimos anos&#44; bem como os esfor&#231;os para reduzir a radia&#231;&#227;o a que os doentes s&#227;o expostos&#44; sendo atualmente usual realizar exames com doses de radia&#231;&#227;o efetiva inferiores &#224;s de uma CPM ou mesmo de uma coronariografia invasiva<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;26</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Os resultados deste estudo suportam&#44; assim&#44; as mais recentes recomenda&#231;&#245;es cl&#237;nicas para o diagn&#243;stico de DC est&#225;vel do <span class="elsevierStyleItalic">National Institute for Health and Clinical Excellence</span> &#40;NICE&#44; Reino Unido&#41; que&#44; analisando a rentabilidade diagn&#243;stica e custo-efic&#225;cia de cada modalidade&#44; desaconselharam o uso da PE neste contexto<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; As mesmas recomenda&#231;&#245;es prop&#245;em a angio-TC card&#237;aca como exame de primeira linha nos doentes com probabilidade pr&#233;-teste entre 10-29&#37;&#44; testes imagiol&#243;gicos de isquemia para indiv&#237;duos com probabilidade pr&#233;-teste entre 30-60&#37;&#44; e referencia&#231;&#227;o direta para ACI para aqueles com probabilidade pr&#233;-teste &#62;<span class="elsevierStyleHsp" style=""></span>60&#37;&#46; V&#225;rios estudos em curso&#44; entre eles&#44; o estudo <span class="elsevierStyleItalic">PROspective Imaging Study for Evaluation of Chest Pain</span> &#40;PROMISE&#41; e o estudo <span class="elsevierStyleItalic">Computed Tomography versus Exercise Testing in Suspected Coronary Artery Disease</span> &#40;CRESCENT&#41; poder&#227;o fornecer um contributo importante para a compreens&#227;o das vantagens e desvantagens relativas da angio-TC como exame de primeira linha no diagn&#243;stico de doen&#231;a coron&#225;ria&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Este trabalho apresenta algumas limita&#231;&#245;es que importa considerar&#46; Em primeiro lugar&#44; deve real&#231;ar-se que se trata&#44; essencialmente&#44; de um exerc&#237;cio te&#243;rico&#44; cujos resultados est&#227;o dependentes das premissas assumidas&#44; nomeadamente dos valores de sensibilidade e especificidade das 2 t&#233;cnicas&#44; que poder&#227;o&#44; no &#171;mundo real&#187;&#44; ser diferentes das reportadas em estudos efetuados em centros internacionais de refer&#234;ncia<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Uma vez que os doentes n&#227;o foram sistematicamente submetidos a ACI&#44; n&#227;o &#233; poss&#237;vel avaliar a sensibilidade e especificidade reais de cada um dos testes nesta popula&#231;&#227;o&#46; Relativamente &#224; amostra&#44; devemos admitir a hip&#243;tese de que esta possa n&#227;o ser representativa da globalidade dos doentes com suspeita de doen&#231;a coron&#225;ria&#44; uma vez que doentes com cl&#237;nica t&#237;pica ou provas de esfor&#231;o claramente positivas foram provavelmente referenciados diretamente para coronariografia convencional&#46; Por outro lado&#44; ao contr&#225;rio da angio-TC&#44; que foi interpretada no mesmo centro e pelos mesmos operadores em todos os casos&#44; as provas de esfor&#231;o foram interpretadas pelos m&#233;dicos que as realizaram e&#47;ou pelos respetivos m&#233;dicos assistentes&#44; n&#227;o havendo forma de garantir a reprodutibilidade dos crit&#233;rios utilizados&#46; &#201; tamb&#233;m importante recordar que&#44; pela sua pr&#243;pria natureza&#44; a correla&#231;&#227;o entre os achados de testes funcionais e anat&#243;micos n&#227;o &#233; perfeita<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#44; o que pode explicar parte da diverg&#234;ncia de resultados observada neste estudo&#46; Por &#250;ltimo&#44; neste trabalho apenas consider&#225;mos como crit&#233;rios diagn&#243;sticos na PE as altera&#231;&#245;es do segmento ST e a presen&#231;a de dor tor&#225;cica durante a prova&#44; e classific&#225;mos as provas conclusivas como positivas ou negativas&#44; numa dicotomiza&#231;&#227;o que &#233; redutora mas praticamente inevit&#225;vel neste tipo de an&#225;lise&#46; No entanto&#44; embora o uso de <span class="elsevierStyleItalic">scores</span> como o <span class="elsevierStyleItalic">score</span> de Duke tenha valor progn&#243;stico reconhecido&#44; a sua acuidade diagn&#243;stica continua a ser muito inferior &#224; da angio-TC&#44; com sensibilidade e especificidade de 75 e 50&#37;&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">Ao contr&#225;rio da PE&#44; o uso da angio-TC como exame diagn&#243;stico de primeira linha permite reclassificar o risco na maioria dos doentes que apresentam probabilidade interm&#233;dia de doen&#231;a coron&#225;ria obstrutiva por crit&#233;rios cl&#237;nicos&#46; O uso da angio-TC como exame inicial poder&#225; ser uma alternativa clinicamente vantajosa neste contexto&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflito de interesses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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              "titulo" => "Probabilidade pr&#233;-teste"
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              "identificador" => "sec0020"
              "titulo" => "Prova de esfor&#231;o"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Angio-TC coron&#225;ria"
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              "identificador" => "sec0030"
              "titulo" => "Probabilidade p&#243;s-teste"
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              "titulo" => "An&#225;lise estat&#237;stica"
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          "titulo" => "Bibliografia"
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    "fechaRecibido" => "2012-01-01"
    "fechaAceptado" => "2012-06-04"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec238178"
          "palabras" => array:4 [
            0 => "Doen&#231;a coron&#225;ria"
            1 => "T&#233;cnicas diagn&#243;sticas"
            2 => "Angio-TC coron&#225;ria"
            3 => "Prova de esfor&#231;o"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Coronary artery disease"
            1 => "Diagnostic techniques"
            2 => "Coronary CT angiography"
            3 => "Exercise test"
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    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste estudo foi avaliar a evolu&#231;&#227;o da probabilidade te&#243;rica de doen&#231;a coron&#225;ria &#40;DC&#41; obstrutiva em doentes que efetuaram angio-TC card&#237;aca como exame de primeira linha <span class="elsevierStyleItalic">versus</span> doentes submetidos a angio-TC ap&#243;s prova de esfor&#231;o &#40;PE&#41;&#44; por suspeita cl&#237;nica de doen&#231;a coron&#225;ria&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analis&#225;mos 158 doentes que efetuaram&#44; por suspeita de doen&#231;a coron&#225;ria&#44; angio-TC como exame de primeira linha &#40;grupo A&#41; e 134 doentes ap&#243;s PE &#40;grupo B&#41;&#46; Em cada doente&#44; a probabilidade pr&#233;-teste de DC obstrutiva foi estimada com base no sexo&#44; idade e sintomatologia&#46; As probabilidades p&#243;s-teste foram calculadas de acordo com o teorema de Bayes&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">N&#227;o se registaram diferen&#231;as significativas entre os dois grupos quanto &#224; probabilidade pr&#233;-teste inicial &#40;mediana 23&#44;5&#37; &#91;13&#44;3-37&#44;8&#93; no grupo A <span class="elsevierStyleItalic">versus</span> 20&#44;5&#37; &#91;13&#44;4-34&#44;5&#93; no grupo B&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;479&#41;&#46; No grupo A&#44; a percentagem de doentes com probabilidade interm&#233;dia &#40;10-90&#37;&#41; foi de 90&#37; antes do exame&#44; e de 15&#37; ap&#243;s a angio-TC &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No grupo B&#44; a percentagem de doentes com probabilidade interm&#233;dia foi de 95&#37; antes dos exames&#44; de 87&#37; ap&#243;s a PE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#44; e de 17&#37; ap&#243;s a angio-TC &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ao contr&#225;rio da PE&#44; a angio-TC permite reclassificar o risco na maioria dos doentes que apresentam probabilidade interm&#233;dia de DC obstrutiva&#46; O uso da angio-TC como exame diagn&#243;stico de primeira linha poder&#225; ser vantajoso neste contexto&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study was to assess the change in theoretical probability of coronary artery disease &#40;CAD&#41; in patients with suspected CAD undergoing coronary CT angiography &#40;CCTA&#41; as first line test vs&#46; patients who underwent CCTA after an exercise ECG&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-test probabilities of CAD were assessed in 158 patients with suspected CAD undergoing dual-source CCTA as the first-line test &#40;Group A&#41; and in 134 in whom CCTA was performed after an exercise ECG &#40;Group B&#41;&#46; Pre-test probabilities were calculated based on age&#44; gender and type of chest pain&#46; Post-test probabilities were calculated according to Bayes&#8217; theorem&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There were no significant differences between the groups regarding pre-test probability &#40;median 23&#46;5&#37; &#91;13&#46;3-37&#46;8&#93; in group A vs&#46; 20&#46;5&#37; &#91;13&#46;4-34&#46;5&#93; in group B&#59; p&#61;0&#44;479&#41;&#46; In group A&#44; the percentage of patients with intermediate likelihood of disease &#40;10-90&#37;&#41; was 90&#37; before testing and 15&#37; after CCTA &#40;p&#60;0&#44;001&#41;&#44; while in group B&#44; it was 95&#37; before testing&#44; 87&#37; after exercise ECG &#40;p&#61;NS&#41;&#44; and 17&#37; after CCTA &#40;p&#60;0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Unlike exercise testing&#44; CCTA is able to reclassify the risk in the majority of patients with an intermediate probability of obstructive CAD&#46; The use of CCTA as a first-line diagnostic test for CAD may be beneficial in this setting&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A e B &#8211; Evolu&#231;&#227;o da probabilidade te&#243;rica de doen&#231;a coron&#225;ria obstrutiva em cada indiv&#237;duo dos grupos de estudo A e B&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Angio-TC&#58; angiografia coron&#225;ria por TC&#47;CCTA&#47;coronary CT angiography&#59; DC&#58; doen&#231;a coron&#225;ria obstrutiva&#47;CAD&#58; obstructive coronary artery disease&#59; PE&#58; prova de esfor&#231;o&#47;ExECG&#58; exercise ECG&#46;</p>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A e B &#8211; Evolu&#231;&#227;o da probabilidade te&#243;rica de doen&#231;a coron&#225;ria obstrutiva nos 2 grupos de estudo&#44; categorizada em muito baixa &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5&#37;&#41;&#44; baixa &#40;5-10&#37;&#41;&#44; interm&#233;dia &#40;10-90&#37;&#41; e elevada probabilidade &#40;&#62;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Angio-TC&#58; angiografia coron&#225;ria por TC&#47;CCTA&#58; coronary CT angiography&#59; PE&#58; prova de esfor&#231;o&#47;ExECG&#58; exercise ECG&#46;</p>"
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A e B &#8211; Varia&#231;&#227;o da probabilidade te&#243;rica de DC obstrutiva nos indiv&#237;duos dos 2 grupos de estudo&#44; de acordo com o teorema de Bayes&#46; A linha pontilhada representa a raz&#227;o de verosimilhan&#231;a negativa ou positiva&#44; assumindo os valores de sensibilidade e especificidade considerados para cada teste&#46; Os c&#237;rculos a cheio representam os valores de probabilidade p&#243;s-teste de cada indiv&#237;duo nos grupos A e B&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Angio-TC&#58; angiografia coron&#225;ria por TC&#47;CCTA&#58; coronary CT angiography&#59; PE&#58; prova de esfor&#231;o&#47;ExECG&#58; exercise ECG&#46;</p>"
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                  \t\t\t\t">Grupo A &#40;angio-TC de primeira linha&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dor tor&#225;cica n&#227;o anginosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Doen&#231;a coron&#225;ria obstrutiva</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a coron&#225;ria de um vaso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a coron&#225;ria de 2 vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a coron&#225;ria de 3 vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;421&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Art&#233;rias coron&#225;rias sem les&#245;es mas com segmentos n&#227;o avali&#225;veis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;5&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&#37;&#91;0&#44;4-1&#44;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;2&#37; &#91;6&#44;0-18&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Probabilidade ap&#243;s segundo exame&#44; nos doentes com PE negativa</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC positiva &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;8&#37; &#91;29&#44;7-68&#44;6&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&#37; &#91;0&#44;2-0&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC positiva &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">90&#44;3&#37; &#91;83&#44;1-91&#44;6&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;6&#37; &#91;1&#44;0-3&#44;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Probabilidade ap&#243;s segundo exame&#44; nos doentes com PE inconclusiva</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC positiva &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80&#44;5&#37; &#91;67&#44;4-88&#44;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angio-TC negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4&#37; &#91;0&#44;4-0&#44;6&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Evolu&#231;&#227;o da probabilidade te&#243;rica de DC obstrutiva nos grupos de estudo A e B</p>"
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC&#47;AHA 2002 guideline update for exercise testing&#58; summary article&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines &#40;Committee to Update the 1997 Exercise Testing Guidelines&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;J&#46; Gibbons"
                            1 => "G&#46;J&#46; Balady"
                            2 => "J&#46;T&#46; Bricker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "106"
                        "paginaInicial" => "1883"
                        "paginaFinal" => "1892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12356646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;SCCT&#47;ACR&#47;AHA&#47;ASE&#47;ASNC&#47;NASCI&#47;SCAI&#47;SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography&#46; A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force&#44; the Society of Cardiovascular Computed Tomography&#44; the American College of Radiology&#44; the American Heart Association&#44; the American Society of Echocardiography&#44; the American Society of Nuclear Cardiology&#44; the North American Society for Cardiovascular Imaging&#44; the Society for Cardiovascular Angiography and Interventions&#44; and the Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Taylor"
                            1 => "M&#46; Cerqueira"
                            2 => "J&#46;M&#46; Hodgson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcct.2010.11.001"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiovasc Comput Tomogr"
                        "fecha" => "2010"
                        "volumen" => "4"
                        "paginaInicial" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21232696"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical prediction rule for the diagnosis of coronary artery disease&#58; validation&#44; updating&#44; and extension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;S&#46; Genders"
                            1 => "E&#46;W&#46; Steyerberg"
                            2 => "H&#46; Alkadhi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehr014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "1316"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21367834"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;A&#46; Diamond"
                            1 => "J&#46;S&#46; Forrester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM197906143002402"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1979"
                        "volumen" => "300"
                        "paginaInicial" => "1350"
                        "paginaFinal" => "1358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/440357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bayesian probability analysis&#58; a prospective demonstration of its clinical utility in diagnosing coronary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Detrano"
                            1 => "J&#46; Yiannikas"
                            2 => "E&#46;E&#46; Salcedo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1984"
                        "volumen" => "69"
                        "paginaInicial" => "541"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6692516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability of Bayesian probability analysis for predicting coronary artery disease in a veterans hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Detrano"
                            1 => "K&#46;H&#46; Guppy"
                            2 => "N&#46; Abbassi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "1988"
                        "volumen" => "41"
                        "paginaInicial" => "599"
                        "paginaFinal" => "605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3385460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic performance of multi-slice coronary computed tomographic angiography&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Ollendorf"
                            1 => "M&#46; Kuba"
                            2 => "S&#46;D&#46; Pearson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11606-010-1556-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gen Intern Med"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "307"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21063800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2007 chronic angina focused update of the ACC&#47;AHA 2002 guidelines for the management of patients with chronic stable angina&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;D&#46; Fraker Jr"
                            1 => "S&#46;D&#46; Fihn"
                            2 => "R&#46;J&#46; Gibbons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.08.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "50"
                        "paginaInicial" => "2264"
                        "paginaFinal" => "2274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18061078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Low diagnostic yield of elective coronary angiography"
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                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Patel"
                            1 => "E&#46;D&#46; Peterson"
                            2 => "D&#46; Dai"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0907272"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "886"
                        "paginaFinal" => "895"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20220183"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of the traditional age&#44; sex&#44; and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography&#58; results from the multinational coronary CT angiography evaluation for clinical outcomes&#58; an international multicenter registry &#40;CONFIRM&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46;Y&#46; Cheng"
                            1 => "D&#46;S&#46; Berman"
                            2 => "A&#46; Rozanski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.111.039255"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "2423"
                        "paginaFinal" => "2432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22025600"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Maffei"
                            1 => "S&#46; Seitun"
                            2 => "C&#46; Martini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2009.191361"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2010"
                        "volumen" => "96"
                        "paginaInicial" => "1973"
                        "paginaFinal" => "1979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronariografia para avalia&#231;&#227;o de doen&#231;a coron&#225;ria obstrutiva&#58; estamos a selecionar bem os doentes&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Borges Santos"
                            1 => "A&#46;M&#46; Ferreira"
                            2 => "A&#46; Monteiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "numero" => "Suppl I"
                        "paginaInicial" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Chow"
                            1 => "A&#46; Abraham"
                            2 => "G&#46;A&#46; Wells"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.108.792572"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "16"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808560"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise capacity and mortality among men referred for exercise testing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Myers"
                            1 => "M&#46; Prakash"
                            2 => "V&#46; Froelicher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa011858"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2002"
                        "volumen" => "346"
                        "paginaInicial" => "793"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11893790"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM&#58; COroNary computed tomography angiography evaluation for clinical outcomes&#58; an InteRnational Multicenter registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Chow"
                            1 => "G&#46; Small"
                            2 => "Y&#46; Yam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circ Cardiovas Imaging"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "463"
                        "paginaFinal" => "472"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Bamberg"
                            1 => "W&#46;H&#46; Sommer"
                            2 => "V&#46; Hoffmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2010.12.043"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2011"
                        "volumen" => "57"
                        "paginaInicial" => "2426"
                        "paginaFinal" => "2436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21658564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stable angina pectoris&#58; head-to-head comparison of prognostic value of cardiac CT and exercise testing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Dedic"
                            1 => "T&#46;S&#46; Genders"
                            2 => "B&#46;S&#46; Ferket"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.11110744"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2011"
                        "volumen" => "261"
                        "paginaInicial" => "428"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21873254"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ollendorf DA&#44; Gohler A&#44; Pearson SD&#44; et al&#46; Coronary computed tomographic angiography for detection of coronary artery disease - Final appraisal document&#46; Institute for Clinical and Economic Review &#40;ICER&#41; &#91;Internet&#93;&#46; Boston&#44; USA&#44; 2009 &#91;consultado 14 Dez 2012&#93;&#46; Dispon&#237;vel em&#58; <a class="elsevierStyleInterRef" href="http://www.icer-review.org/index.php/Download-document/47-CCTA-Final-Appraisal-Full-Report.html">http&#58;&#47;&#47;www&#46;icer-review&#46;org&#47;index&#46;php&#47;Download-document&#47;47-CCTA-Final-Appraisal-Full-Report&#46;html</a>"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Dewey"
                            1 => "B&#46; Hamm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00330-006-0439-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Radiol"
                        "fecha" => "2007"
                        "volumen" => "17"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1309"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17031453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CT stress myocardial perfusion imaging using multidetector CT - A review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;S&#46; Ko"
                            1 => "J&#46;D&#46; Cameron"
                            2 => "T&#46; Defrance"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcct.2011.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Comput Tomogr"
                        "fecha" => "2011"
                        "volumen" => "5"
                        "paginaInicial" => "345"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22146494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Bettencourt"
                            1 => "J&#46; Rocha"
                            2 => "N&#46; Ferreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcct.2011.10.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Comput Tomogr"
                        "fecha" => "2011"
                        "volumen" => "5"
                        "paginaInicial" => "392"
                        "paginaFinal" => "405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22146498"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms&#46; Results from the prospective multicenter DISCOVER-FLOW &#40;Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;K&#46; Koo"
                            1 => "A&#46; Erglis"
                            2 => "J&#46;H&#46; Doh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.06.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "1989"
                        "paginaFinal" => "1997"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22032711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiation in cardiac CT&#58; predictors of higher dose and its reduction over time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;J&#46; Sousa"
                            1 => "P&#46;A&#46; Gon&#231;alves"
                            2 => "H&#46; Marques"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2010"
                        "volumen" => "29"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21309355"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique&#58; improved image quality and reduced radiation dose"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Earls"
                            1 => "E&#46;L&#46; Berman"
                            2 => "B&#46;A&#46; Urban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2463070989"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2008"
                        "volumen" => "246"
                        "paginaInicial" => "742"
                        "paginaFinal" => "753"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector Computed Tomographic angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Gopal"
                            1 => "S&#46;S&#46; Mao"
                            2 => "D&#46; Karlsberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10554-008-9396-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "405"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19051055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ionizing radiation risks of cardiac imaging&#58; estimates of the immeasurable"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Kaufmann"
                            1 => "J&#46; Knuuti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq298"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "269"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20829211"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NICE guidance&#46; Chest pain of recent onset&#58; assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Chest Pain Guideline Development Group"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Skinner"
                            1 => "L&#46; Smeeth"
                            2 => "J&#46;M&#46; Kendall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2009.190066"
                      "Revista" => array:7 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2010"
                        "volumen" => "96"
                        "paginaInicial" => "974"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20538674"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204509700038"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ontario multidetector computed tomographic coronary angiography study&#58; field evaluation of diagnostic accuracy"
                      "autores" => array:1 [
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