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subdiagnosticada&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">As manifesta&#231;&#245;es cl&#237;nicas mais frequentes s&#227;o a insufici&#234;ncia card&#237;aca&#44; as arritmias ventriculares e os fen&#243;menos tromboemb&#243;licos&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O diagn&#243;stico &#233; tradicionalmente efetuado por ecocardiograma&#44; embora a resson&#226;ncia magn&#233;tica nuclear &#40;RMN&#41; esteja a assumir um papel cada vez mais relevante neste dom&#237;nio&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Apesar de o interesse crescente despertado por esta cardiomiopatia&#44; a sua hist&#243;ria natural &#233; pouco clara e a melhor estrat&#233;gia terap&#234;utica ainda est&#225; por definir&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Este trabalho tem por objetivo descrever a popula&#231;&#227;o de doentes com NCIVE seguidos no nosso centro&#44; no que refere &#224; sua apresenta&#231;&#227;o cl&#237;nica&#44; diagn&#243;stico&#44; estratifica&#231;&#227;o de risco&#44; terap&#234;utica institu&#237;da e evolu&#231;&#227;o cl&#237;nica&#46; Paralelamente&#44; procede-se &#224; discuss&#227;o da literatura atual mais relevante acerca deste tema&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Analisamos retrospetivamente os registos cl&#237;nicos dos doentes com o diagn&#243;stico de NCIVE seguidos na consulta externa de Cardiologia do nosso hospital&#44; at&#233; dezembro de 2011&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos os doentes foram avaliados por ecocardiograma bidimensional com Doppler codificado a cor &#40;ecocardi&#243;grafos <span class="elsevierStyleItalic">iE33&#44; Philips Medical Systems</span>&#41;&#46; Em todos&#44; o estudo foi complementado com ecocardiografia tridimensional e&#44; num doente&#44; foi utilizado contraste para exclus&#227;o de trombo intraventricular&#46; Foram considerados os crit&#233;rios de diagn&#243;stico de Jenni&#58; rela&#231;&#227;o entre a espessura da camada n&#227;o compactada e a espessura da camada compactada<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2 &#40;medidas em s&#237;stole&#41;&#44; presen&#231;a de numerosas trabecula&#231;&#245;es proeminentes e de recessos intertrabeculares profundos preenchidos por sangue da cavidade ventricular &#40;demonstrado no Doppler a cor&#41;&#44; aus&#234;ncia de anomalias estruturais card&#237;acas associadas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Em todos os doentes&#44; o diagn&#243;stico foi confirmado por RMN <span class="elsevierStyleItalic">&#40;1&#46;5-Tesla Magneton Symphony&#44; Siemens Medical Solutions&#41;</span>&#46; Foram utilizados os crit&#233;rios de Petersen&#58; rela&#231;&#227;o entre a espessura da camada n&#227;o compactada e a espessura da camada compactada<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#44;3 &#40;medidas em teledi&#225;stole&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Todos os doentes realizaram eletrocardiograma &#40;ECG&#41; basal e monitoriza&#231;&#227;o ambulat&#243;ria por Holter&#46; A realiza&#231;&#227;o de prova de esfor&#231;o ou prova cardiopulmonar seguiu o crit&#233;rio do m&#233;dico assistente&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os doentes com compromisso da fun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo &#40;VE&#41; foram avaliados por tomografia computadorizada multidetetores &#40;TCMD&#41; ou cateterismo card&#237;aco para despiste de doen&#231;a coron&#225;ria&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A realiza&#231;&#227;o de estudo eletrofisiol&#243;gico &#40;EEF&#41; para estratifica&#231;&#227;o de risco arr&#237;tmico ficou &#224; considera&#231;&#227;o do m&#233;dico assistente&#46; O protocolo de estimula&#231;&#227;o el&#233;trica programada pr&#233;-estabelecido consistiu em dois ciclos base e dois extraest&#237;mulos prolongados at&#233; ao per&#237;odo refrat&#225;rio ventricular ou at&#233; ao acoplamento m&#237;nimo de 200 mseg&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A todos os doentes foi proposto o rastreio ecocardiogr&#225;fico dos familiares em primeiro grau&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os doentes &#237;ndex com formas familiares de NCIVE realizaram estudo gen&#233;tico com pesquisa de muta&#231;&#245;es nos genes TAZ e LDB3&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">O tempo mediano de seguimento foi de 36&#44;5 meses &#40;8-53 meses&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">At&#233; dezembro de 2011&#44; foram diagnosticados 10 doentes &#40;primeiro caso em julho de 2007&#41;&#44; todos de ra&#231;a caucasiana&#44; 6 do sexo masculino &#40;60&#37;&#41;&#44; com idade mediana de 48 anos &#40;13-72 anos&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">&#192; data do diagn&#243;stico&#44; 4 doentes apresentavam queixas de insufici&#234;ncia card&#237;aca&#58; um encontrava-se em classe <span class="elsevierStyleSmallCaps">iii</span> da <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41; e 3 em classe <span class="elsevierStyleSmallCaps">ii</span>&#46; Nos restantes doentes&#44; a indica&#231;&#227;o para realiza&#231;&#227;o de ecocardiograma foi diversa &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46; Uma jovem de 18 anos referia epis&#243;dios de s&#237;ncope&#44; tendo sido documentado um epis&#243;dio de taquicardia ventricular &#40;TV&#41; monom&#243;rfica sustentada numa prova de esfor&#231;o&#46; Dois doentes apresentavam queixas de palpita&#231;&#245;es&#44; tendo sido documentada fibrilha&#231;&#227;o auricular &#40;FA&#41; parox&#237;stica num deles e n&#227;o se identificando nenhuma arritmia no outro&#46; Um doente referia queixas de dor tor&#225;cica at&#237;pica&#46; Um adolescente de 13 anos foi diagnosticado na sequ&#234;ncia de uma avalia&#231;&#227;o m&#233;dico-desportiva&#46; Um doente foi identificado atrav&#233;s do rastreio familiar de um caso &#237;ndex&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Nenhum dos doentes tinha hist&#243;ria familiar de cardiomiopatia ou morte s&#250;bita card&#237;aca&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Em 3 doentes observaram-se dismorfias faciais &#40;palato arqueado&#44; implanta&#231;&#227;o baixa dos pavilh&#245;es auriculares&#44; proemin&#234;ncia da regi&#227;o frontal&#41;&#44; sendo que os tr&#234;s apresentavam formas familiares de NCIVE&#46; N&#227;o se encontraram doen&#231;as neuromusculares associadas &#40;embora apenas tr&#234;s doentes tenham sido avaliados por um neurologista&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">No que se refere aos achados ecocardiogr&#225;ficos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#44; seis doentes apresentavam dilata&#231;&#227;o do VE&#44; sendo ligeira em dois casos e moderada nos restantes quatro&#46; Sete doentes evidenciavam hipocin&#233;sia global do VE com depress&#227;o da sua fun&#231;&#227;o sist&#243;lica &#40;ligeira num doente&#44; moderada em quatro e grave em dois&#41;&#46; A regi&#227;o mais frequentemente envolvida pela n&#227;o compacta&#231;&#227;o foi o &#225;pex&#44; seguida das paredes posterior e lateral&#44; com um atingimento preferencial dos segmentos m&#233;dio e apical&#46; Em dois casos&#44; a hipertrabecula&#231;&#227;o envolvia tamb&#233;m o &#225;pex do ventr&#237;culo direito &#40;VD&#41;&#46; A espessura das paredes ventriculares encontrava-se dentro dos limites normais ou ligeiramente aumentada&#46; Cinco doentes apresentavam dilata&#231;&#227;o da aur&#237;cula esquerda&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o por RMN&#44; foi observada a presen&#231;a de realce tardio com <span class="elsevierStyleItalic">gadolinium</span> em dois doentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Dos sete doentes submetidos a coronariografia por TCMD ou cateterismo card&#237;aco&#44; apenas um apresentava doen&#231;a coron&#225;ria &#40;les&#227;o &#250;nica de 70&#37; na art&#233;ria circunflexa proximal&#41;&#46; Este doente foi submetido a uma cintigrafia de perfus&#227;o mioc&#225;rdica&#44; que n&#227;o revelou defeitos de perfus&#227;o em repouso e em esfor&#231;o&#44; tendo sido considerado que a doen&#231;a coron&#225;ria encontrada n&#227;o justificava a dilata&#231;&#227;o e compromisso da fun&#231;&#227;o do VE&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">O ECG basal mostrava altera&#231;&#245;es em sete doentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; As anomalias mais frequentemente encontradas foram as perturba&#231;&#245;es da condu&#231;&#227;o intraventricular esquerda &#40;bloqueio completo de ramo esquerdo e bloqueio de fasc&#237;culo anterior esquerdo&#41;&#46; Foram tamb&#233;m observadas altera&#231;&#245;es da repolariza&#231;&#227;o ventricular&#44; crit&#233;rios de hipertrofia ventricular esquerda&#44; bloqueio auriculoventricular de primeiro grau e ondas Q patol&#243;gicas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A monitoriza&#231;&#227;o ambulat&#243;ria por Holter revelou extrassistolia ventricular frequente em dois doentes e curtos per&#237;odos isolados de taquicardia ventricular n&#227;o sustentada &#40;TVNS&#41; em outros dois doentes&#46; Um doente apresentava per&#237;odos de FA parox&#237;stica&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Quatro doentes realizaram prova cardiopulmonar&#44; que demonstrou uma capacidade funcional normal em todos os casos&#44; com um VO2 pico mediano de 36<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min &#40;21-53&#41; e um atingimento mediano de 116&#37; do valor preditivo &#40;90-123&#41;&#46; De salientar que 3 destes doentes apresentavam depress&#227;o da fun&#231;&#227;o sist&#243;lica do VE&#46; Outros 3 doentes realizaram prova de esfor&#231;o&#44; com boa toler&#226;ncia ao exerc&#237;cio e aus&#234;ncia de arritmias&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Cinco doentes foram submetidos a EEF para estratifica&#231;&#227;o de risco arr&#237;tmico &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; Dos restantes&#44; dois foram referenciados diretamente para implanta&#231;&#227;o de cardioversor-desfibrilhador &#40;CDI&#41; por disfun&#231;&#227;o ventricular &#40;DV&#41; esquerda grave&#44; 2 n&#227;o realizaram EEF por decis&#227;o do m&#233;dico assistente e um por recusa do pr&#243;prio doente&#46; Ap&#243;s estimula&#231;&#227;o el&#233;trica programada segundo o protocolo pr&#233;-estabelecido&#44; foi induzida TV polim&#243;rfica sincopal em 2 doentes &#40;um com TV monom&#243;rfica sustentada espont&#226;nea j&#225; documentada&#59; o outro sem arritmias documentadas&#44; com DV moderada&#44; assintom&#225;tico&#41;&#46; Nos restantes doentes&#44; n&#227;o foi induzida qualquer arritmia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">O rastreio ecocardiogr&#225;fico de familiares em primeiro grau foi positivo em dois casos &#40;o pai de um doente &#237;ndex foi diagnosticado desta forma e encontra-se inclu&#237;do nesta s&#233;rie&#59; a filha de outro doente &#237;ndex&#44; na altura com sete anos de idade&#44; foi referenciada a uma consulta de cardiologia pedi&#225;trica e&#44; portanto&#44; foi exclu&#237;da desta s&#233;rie&#41;&#46; Conv&#233;m referir que o rastreio n&#227;o foi completo em todas as fam&#237;lias devido &#224; recusa de alguns elementos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">O estudo gen&#233;tico&#44; realizado nos 2 doentes &#237;ndex com formas familiares de NCIVE&#44; foi negativo num caso e encontra-se em curso no outro&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No que se refere &#224; terap&#234;utica institu&#237;da&#44; todos os doentes com depress&#227;o moderada ou grave da fun&#231;&#227;o sist&#243;lica do VE e&#47;ou fibrilha&#231;&#227;o auricular iniciaram hipocoagula&#231;&#227;o oral&#46; Os restantes doentes &#40;exceto um adolescente com 13 anos&#41; foram submetidos a antiagrega&#231;&#227;o plaquet&#225;ria com &#225;cido acetilsalic&#237;lico&#46; Todos receberam terap&#234;utica para insufici&#234;ncia card&#237;aca de acordo com o estado da arte&#46; Quatro doentes foram submetidos a implanta&#231;&#227;o de CDI&#58; um em contexto de preven&#231;&#227;o secund&#225;ria &#40;TV espont&#226;nea&#44; reprodut&#237;vel no EEF&#41; e tr&#234;s em contexto de preven&#231;&#227;o prim&#225;ria &#40;dois por DV esquerda grave e um por TV indut&#237;vel no EEF&#41;&#46; Os restantes doentes mantiveram vigil&#226;ncia cl&#237;nica com realiza&#231;&#227;o peri&#243;dica de Holter&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Ap&#243;s um per&#237;odo de seguimento mediano de 36&#44;5 meses &#40;8-53 meses&#41;&#44; a sobrevida foi de 100&#37;&#46; Os doentes assintom&#225;ticos na altura do diagn&#243;stico permaneceram assintom&#225;ticos e&#44; dos 4 doentes com insufici&#234;ncia card&#237;aca&#44; 3 mantiveram-se est&#225;veis &#40;classe <span class="elsevierStyleSmallCaps">ii</span>&#41; e um melhorou com a terap&#234;utica &#40;transitou da classe <span class="elsevierStyleSmallCaps">iii</span> para a classe <span class="elsevierStyleSmallCaps">ii</span>&#41;&#46; A avalia&#231;&#227;o ecocardiogr&#225;fica seriada n&#227;o mostrou progress&#227;o da DV esquerda&#46; N&#227;o se registaram eventos tromboemb&#243;licos&#46; Aos 32 meses de seguimento&#44; foi documentada uma terapia apropriada do CDI no doente tratado em preven&#231;&#227;o secund&#225;ria&#46; N&#227;o se observaram terapias &#40;apropriadas e inapropriadas&#41; nos doentes tratados em preven&#231;&#227;o prim&#225;ria&#44; tendo sido registados curtos per&#237;odos de TVNS assintom&#225;tica em todos eles&#46; Nos doentes em vigil&#226;ncia cl&#237;nica n&#227;o se registaram taquiarritmias ventriculares&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0155" class="elsevierStylePara elsevierViewall">Apesar de a nossa experi&#234;ncia relativamente &#224; NCIVE ser&#44; ainda&#44; recente e limitada&#44; a decis&#227;o de a publicar prende-se com a necessidade de contribuir para a caracteriza&#231;&#227;o desta miocardiopatia&#44; nomeadamente&#44; no que se refere &#224; popula&#231;&#227;o portuguesa&#46; Trata-se de uma s&#233;rie algo heterog&#233;nea na forma como foi estudada e orientada&#44; o que reflete a aus&#234;ncia de recomenda&#231;&#245;es universais relativas &#224; abordagem desta patologia&#46; Por este motivo&#44; fazemos o contraponto com o que mais recentemente tem sido publicado na literatura acerca do assunto&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A &#171;persist&#234;ncia de sinusoides no mioc&#225;rdio ventricular&#187; foi inicialmente descrita em associa&#231;&#227;o a cardiopatias cong&#233;nitas com obstru&#231;&#227;o dos tratos de sa&#237;da ventriculares ou atresia das v&#225;lvulas semilunares<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Nestes casos&#44; foi sugerido que a sobrecarga de press&#227;o intraventricular impediria a regress&#227;o dos sinusoides mioc&#225;rdicos embrion&#225;rios&#44; resultando em recessos intertrabeculares em comunica&#231;&#227;o com a cavidade ventricular e com a circula&#231;&#227;o coron&#225;ria&#46; A primeira descri&#231;&#227;o de &#171;persist&#234;ncia isolada de sinusoides mioc&#225;rdicos&#187; remonta a 1984&#44; quando Engberding e Bender descreveram esta morfologia mioc&#225;rdica na aus&#234;ncia de outros defeitos card&#237;acos que justificassem o desenvolvimento anormal do mioc&#225;rdio<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; A designa&#231;&#227;o de &#171;n&#227;o compacta&#231;&#227;o isolada do mioc&#225;rdio ventricular esquerdo&#187; foi introduzida em 1990 por Chin et al&#46; e sugere como mecanismo etiol&#243;gico prov&#225;vel uma perturba&#231;&#227;o do normal processo de compacta&#231;&#227;o do mioc&#225;rdio<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Durante o desenvolvimento embriol&#243;gico precoce&#44; o mioc&#225;rdio consiste numa rede &#171;esponjosa&#187; de fibras entrela&#231;adas em trab&#233;culas e recessos intertrabeculares que comunicam com a cavidade do ventr&#237;culo&#44; de onde prov&#233;m o seu suprimento sangu&#237;neo&#46; Entre a quinta e a oitava semanas de vida embrion&#225;ria decorre a compacta&#231;&#227;o gradual do mioc&#225;rdio&#44; que se inicia do epic&#225;rdio para o endoc&#225;rdio e da base para o &#225;pex&#46; A circula&#231;&#227;o coron&#225;ria epic&#225;rdica desenvolve-se concomitantemente e os recessos intertrabeculares s&#227;o reduzidos a capilares&#46; Uma interrup&#231;&#227;o geneticamente determinada deste processo tem sido considerada como o mecanismo respons&#225;vel pela NCIVE&#46; Alguns autores t&#234;m descrito casos de NCIVE aparentemente adquirida&#44; sobretudo em associa&#231;&#227;o a doen&#231;as neuromusculares&#44; sugerindo que este poder&#225; n&#227;o ser o &#250;nico mecanismo patog&#233;nico envolvido<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11</span></a>&#46; No entanto&#44; mesmo nestas situa&#231;&#245;es&#44; o fen&#243;tipo de n&#227;o compacta&#231;&#227;o poder&#225; desenvolver-se em resposta a certos est&#237;mulos apenas em indiv&#237;duos geneticamente predispostos ou com uma estrutura mioc&#225;rdica espec&#237;fica<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Apesar de ainda estar inclu&#237;da no grupo das cardiomiopatias n&#227;o classificadas segundo a Organiza&#231;&#227;o Mundial de Sa&#250;de<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; mais recentemente a <span class="elsevierStyleItalic">American Heart Association</span> classificou-a como uma cardiomiopatia prim&#225;ria gen&#233;tica<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">O processo de normal compacta&#231;&#227;o &#233; mais completo no VE do que no VD&#44; o que confere a este &#250;ltimo uma apar&#234;ncia mais trabeculada&#46; Por este motivo&#44; a distin&#231;&#227;o entre variantes normais e formas patol&#243;gicas de n&#227;o compacta&#231;&#227;o no VD &#233; mais dif&#237;cil e diversos autores optam por restringir o diagn&#243;stico de n&#227;o compacta&#231;&#227;o ao VE<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;15</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A verdadeira preval&#234;ncia da NCIVE &#233; desconhecida&#44; sendo habitualmente considerado que se encontra subdiagnosticada&#46; Estudos observacionais reportaram uma preval&#234;ncia inferior a 0&#44;14&#37; em adultos referenciados para ecocardiograma<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Na nossa s&#233;rie&#44; a distribui&#231;&#227;o et&#225;ria &#224; altura do diagn&#243;stico encontra-se entre os 13 e os 72 anos&#44; sendo a maioria do sexo masculino&#46; Apesar de inicialmente descrita como uma patologia rara afetando crian&#231;as&#44; encontram-se descritos na literatura v&#225;rios casos de apresenta&#231;&#227;o tardia na vida adulta&#46; Os homens parecem ser mais afetados do que as mulheres e v&#225;rias explica&#231;&#245;es foram propostas<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;17</span></a>&#46; Por um lado&#44; existem formas com hereditariedade ligada ao cromossoma X&#46; Por outro lado&#44; &#233; poss&#237;vel que as mulheres sejam afetadas por formas mais graves&#44; logo&#44; com uma mortalidade precoce mais elevada&#44; o que explicaria o predom&#237;nio do sexo feminino encontrado em algumas s&#233;ries pedi&#225;tricas&#46; Outra hip&#243;tese &#233; que os homens sejam mais predispostos ao desenvolvimento de formas adquiridas&#46; Al&#233;m disso&#44; &#233; poss&#237;vel que haja um vi&#233;s de sele&#231;&#227;o na referencia&#231;&#227;o para ecocardiograma&#44; com favorecimento do sexo masculino&#46; &#201; ainda necess&#225;rio considerar que os crit&#233;rios de diagn&#243;stico atuais n&#227;o s&#227;o ajustados ao sexo&#46; Um estudo recente demonstrou existirem diferen&#231;as entre os sexos na localiza&#231;&#227;o e extens&#227;o da n&#227;o compacta&#231;&#227;o&#44; com as mulheres a apresentarem uma maior &#225;rea atingida e envolvendo&#44; preferencialmente&#44; as paredes anterior&#44; lateral e &#237;nfero-posterior&#44; e os homens a evidenciarem uma &#225;rea de n&#227;o compacta&#231;&#227;o mais restrita e&#44; sobretudo&#44; apical&#46; Contudo&#44; as diferen&#231;as encontradas n&#227;o se traduziram em caracter&#237;sticas cl&#237;nicas ou progn&#243;sticos distintos<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Uma quest&#227;o atualmente muito debatida &#233; a limita&#231;&#227;o decorrente da aus&#234;ncia de crit&#233;rios de diagn&#243;stico universalmente aceites&#46; O ecocardiograma transtor&#225;cico tem sido considerado o exame de elei&#231;&#227;o para o diagn&#243;stico da NCIVE&#46; Outras t&#233;cnicas&#44; como o ecocardiograma transesof&#225;gico&#44; o ecocardiograma tridimensional e o ecocardiograma com contraste&#44; podem ser &#250;teis na melhor defini&#231;&#227;o dos contornos do endoc&#225;rdio e no diagn&#243;stico diferencial com cordas tendinosas&#44; m&#250;sculos papilares e bandas musculares&#46; Para al&#233;m de Jenni&#44; cujos crit&#233;rios j&#225; foram previamente referidos &#40;ver m&#233;todos&#41;&#44; outros autores propuseram diferentes crit&#233;rios de diagn&#243;stico ecocardiogr&#225;fico&#46; Chin et al&#46; sugerem que um quociente X&#47;Y&#160;&#8804;&#160;0&#44;5 estabelece o diagn&#243;stico de NCIVE&#44; onde X representa a dist&#226;ncia entre a superf&#237;cie epic&#225;rdica e o fundo de um recesso intertrabecular e Y corresponde &#224; dist&#226;ncia entre a superf&#237;cie epic&#225;rdica e o pico de uma trab&#233;cula &#40;medidas em teledi&#225;stole&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; J&#225; St&#246;llberger et al&#46; prop&#245;em que o diagn&#243;stico de NCIVE pode ser estabelecido quando existem mais de tr&#234;s trabecula&#231;&#245;es com origem na parede do VE &#40;apicais em rela&#231;&#227;o aos m&#250;sculos papilares e vis&#237;veis num &#250;nico plano de imagem&#41; e recessos intertrabeculares perfundidos a partir da cavidade ventricular &#40;visualizados no Doppler a cor&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Em 2008&#44; Kohli et al&#46; demonstraram que os crit&#233;rios ecocardiogr&#225;ficos propostos por estes tr&#234;s autores apresentam fraca correla&#231;&#227;o entre si e s&#227;o demasiado sens&#237;veis&#44; particularmente nos indiv&#237;duos de ra&#231;a negra<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Neste estudo&#44; Kohli levanta a hip&#243;tese de estarmos a assistir a um sobrediagn&#243;stico de NCIVE&#44; com o perigo de estarmos a submeter indiv&#237;duos normais a exames e terap&#234;uticas desnecess&#225;rios e&#44; eventualmente&#44; delet&#233;rios&#46; Por este motivo&#44; &#233; urgente definir o que s&#227;o os limites do normal padr&#227;o de trabecula&#231;&#227;o do VE&#44; para os diferentes sexos e ra&#231;as&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">No nosso centro&#44; optamos por seguir os crit&#233;rios de Jenni por serem os mais frequentemente utilizados&#46; Contudo&#44; confrontamo-nos com a dificuldade em medir a espessura das camadas compactada e n&#227;o compactada de forma rigorosa e reprodut&#237;vel&#44; o que&#44; ali&#225;s&#44; j&#225; tem sido demonstrado por diversos autores<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Por este motivo&#44; todos os doentes foram submetidos a RMN para confirma&#231;&#227;o do diagn&#243;stico&#46; Esta t&#233;cnica&#44; al&#233;m de ter demonstrado uma boa concord&#226;ncia com os achados ecocardiogr&#225;ficos&#44; tem a vantagem de oferecer uma resolu&#231;&#227;o espacial superior&#44; permitindo uma melhor visualiza&#231;&#227;o do &#225;pex e da parede lateral do VE&#44; frequentemente envolvidos pela n&#227;o compacta&#231;&#227;o&#46; Por este motivo&#44; as imagens obtidas por RMN parecem-nos mais adequadas para avalia&#231;&#245;es quantitativas&#46; Os crit&#233;rios tradicionalmente aplicados s&#227;o os propostos por Petersen&#44; j&#225; referidos &#40;ver m&#233;todos&#41;&#46; Em 2010&#44; Jacquier et al&#46; demonstraram que a determina&#231;&#227;o do grau de trabecula&#231;&#227;o do VE&#44; expresso como a massa da camada n&#227;o compactada&#44; pode ser utilizado no diagn&#243;stico da NCIVE&#46; Segundo estes autores&#44; um valor de massa da camada trabeculada superior a 20&#37; da massa global do VE &#233; altamente sens&#237;vel e espec&#237;fico para o diagn&#243;stico de NCIVE<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figuras 1 e 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">Outra vantagem da RMN &#233; a identifica&#231;&#227;o de focos de fibrose subendoc&#225;rdica pelo realce tardio com <span class="elsevierStyleItalic">gadolinium</span>&#44; o que pode ser &#250;til na estratifica&#231;&#227;o do risco arr&#237;tmico destes doentes&#46; Na nossa s&#233;rie&#44; apenas dois doentes apresentavam realce tardio na RMN&#44; n&#227;o tendo sido documentadas arritmias ventriculares malignas em nenhum deles&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">O diagn&#243;stico diferencial faz-se sobretudo com a cardiomiopatia hipertr&#243;fica &#40;CMH&#41; apical e a cardiomiopatia dilatada &#40;CMD&#41;&#46; Uma revis&#227;o dos casos publicados de doentes que n&#227;o foram corretamente diagnosticados na primeira avalia&#231;&#227;o ecocardiogr&#225;fica encontrou como diagn&#243;stico inicial&#44; al&#233;m das duas cardiomiopatias j&#225; citadas&#44; a fibroelastose endomioc&#225;rdica&#44; a cardiomiopatia restritiva&#44; a miocardite&#44; trombos do VE&#44; met&#225;stases card&#237;acas&#44; cordas tendinosas aberrantes e abcessos ou hematomas intramioc&#225;rdicos<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Por outro lado&#44; est&#227;o descritos casos de hipertrabecula&#231;&#227;o marcada em atletas de alta competi&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">O papel da gen&#233;tica no diagn&#243;stico desta cardiomiopatia n&#227;o &#233;&#44; ainda&#44; muito claro&#46; A NCIVE pode ocorrer de forma espor&#225;dica&#44; mas encontram-se formas familiares em mais de 50&#37; dos casos<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Na nossa s&#233;rie&#44; o rastreio de familiares em primeiro grau &#40;apesar de incompleto&#41; foi positivo em dois de nove casos &#237;ndex &#40;22&#37;&#41;&#46; &#192; semelhan&#231;a de outras cardiomiopatias&#44; a NCIVE &#233; uma entidade geneticamente heterog&#233;nea&#44; estando descritas v&#225;rias muta&#231;&#245;es e diferentes formas de transmiss&#227;o&#46; A forma de transmiss&#227;o mais frequentemente encontrada &#233; a autoss&#243;mica dominante&#44; tendo sido tamb&#233;m descritos casos de hereditariedade ligada ao cromossoma X e hereditariedade mitocondrial<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; A NCIVE tem mostrado variabilidade fenot&#237;pica intrafamiliar e reduzida penetr&#226;ncia&#44; com pessoas que partilham a muta&#231;&#227;o familiar a expressar formas assintom&#225;ticas ou subtis<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; Algumas das muta&#231;&#245;es encontradas j&#225; tinham sido descritas em doen&#231;as neuromusculares e em outras cardiomiopatias&#44; nomeadamente&#44; na CMH e na CMD&#46; De facto&#44; os doentes com NCIVE familiar apresentam frequentemente doen&#231;as neuromusculares associadas e s&#227;o encontradas formas de cardiomiopatia hipertr&#243;fica e dilatada nos seus familiares<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; Esta sobreposi&#231;&#227;o genot&#237;pica e fenot&#237;pica tem levado alguns autores a considerar que mais do que tr&#234;s entidades distintas&#44; a NCIVE&#44; a CMH e a CMD constituem um <span class="elsevierStyleItalic">continuum</span> de cardiomiopatias<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Teremos de aguardar por mais estudos at&#233; que o papel da gen&#233;tica no diagn&#243;stico e progn&#243;stico destes doentes e&#44; tamb&#233;m&#44; no seguimento dos seus familiares&#44; esteja mais bem definido&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Na nossa s&#233;rie&#44; a apresenta&#231;&#227;o cl&#237;nica mais frequente foi a insufici&#234;ncia card&#237;aca&#44; o que est&#225; de acordo com as maiores s&#233;ries publicadas<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16&#44;29&#8211;31</span></a>&#46; Observaram-se dismorfias faciais em tr&#234;s doentes&#44; dois deles familiares diretos e o terceiro tamb&#233;m com uma forma familiar de NCIVE&#46; Curiosamente&#44; as dismorfias faciais encontram-se descritas&#44; sobretudo&#44; em s&#233;ries pedi&#225;tricas<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; J&#225; as s&#233;ries de adultos referem habitualmente uma preval&#234;ncia muito menor de dismorfias faciais ou n&#227;o as referem de todo&#44; o que sugere que talvez n&#227;o sejam sistematicamente pesquisadas&#46; Neste grupo de doentes&#44; n&#227;o foram observadas doen&#231;as neuromusculares&#46; Esta associa&#231;&#227;o frequente leva alguns autores a recomendar a avalia&#231;&#227;o sistem&#225;tica por um neurologista<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica revelou disfun&#231;&#227;o sist&#243;lica em sete doentes &#40;70&#37;&#41;&#44; o que est&#225; de acordo com o descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; Apesar de o VE apresentar dimens&#245;es acima do normal em seis doentes&#44; n&#227;o foi observada dilata&#231;&#227;o grave em nenhum doente&#46; Este aspeto&#44; que tamb&#233;m est&#225; de acordo com o reportado&#44; constitui um crit&#233;rio importante no diagn&#243;stico diferencial com a CMD&#44; que se caracteriza habitualmente por um maior grau de dilata&#231;&#227;o do VE&#44; associado a um maior grau de disfun&#231;&#227;o sist&#243;lica e de dilata&#231;&#227;o da AE<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; Os segmentos mais frequentemente envolvidos pela n&#227;o compacta&#231;&#227;o foram os apicais&#44; seguidos dos segmentos m&#233;dios das paredes posterior e lateral&#46; Esta distribui&#231;&#227;o&#44; tamb&#233;m reportada noutras s&#233;ries&#44; poder&#225; estar relacionada com o anormal desenvolvimento embriol&#243;gico j&#225; referido&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Dos sete doentes com compromisso da fun&#231;&#227;o ventricular esquerda&#44; apenas um apresentava doen&#231;a coron&#225;ria e esta n&#227;o era respons&#225;vel pela DV&#46; Diversos estudos com tomografia por emiss&#227;o de positr&#245;es &#40;PET&#41; mostraram a exist&#234;ncia de uma reserva coron&#225;ria diminu&#237;da nos doentes com NCIVE&#44; presumivelmente secund&#225;ria a disfun&#231;&#227;o microvascular<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46; A identifica&#231;&#227;o de defeitos de perfus&#227;o subendoc&#225;rdica em estudos com RMN e a observa&#231;&#227;o em estudos <span class="elsevierStyleItalic">postmortem</span> de focos de fibrose subendoc&#225;rdica corroboram a teoria de que as anomalias na microcircula&#231;&#227;o coron&#225;ria poder&#227;o contribuir para a disfun&#231;&#227;o contr&#225;til e para a arritmog&#233;nese<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#44;36</span></a>&#46; Uma hip&#243;tese apontada &#233; que estas altera&#231;&#245;es da perfus&#227;o e da reserva coron&#225;ria poder&#227;o estar relacionadas com a incapacidade da microcircula&#231;&#227;o coron&#225;ria em acompanhar o crescimento da massa ventricular ou que haja compress&#227;o do leito coron&#225;rio intramioc&#225;rdico pelo mioc&#225;rdio hipertrofiado<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46; Por outro lado&#44; a marcada trabecula&#231;&#227;o do VE pode comprometer igualmente a fun&#231;&#227;o diast&#243;lica&#44; ao condicionar um relaxamento anormal e um enchimento restritivo<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">O ECG &#233; anormal na maioria dos doentes com NCIVE&#44; sendo as altera&#231;&#245;es mais frequentemente encontradas os defeitos de condu&#231;&#227;o intraventricular esquerda<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; o que tamb&#233;m se verificou na nossa s&#233;rie&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Foi documentada taquicardia ventricular em tr&#234;s doentes &#40;30&#37;&#41;&#58; dois epis&#243;dios de TVNS na monitoriza&#231;&#227;o por Holter de dois doentes e um epis&#243;dio de TV monom&#243;rfica sustentada na prova de esfor&#231;o de outro doente&#46; Estes achados v&#227;o ao encontro do reportado na literatura&#44; com registos de TV &#40;sustentada e n&#227;o sustentada&#41; a oscilar entre os 20 e os 47&#37;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16&#44;29</span></a>&#46; Em contraste com estes resultados&#44; numa s&#233;rie italiana de 238 doentes &#40;adultos e crian&#231;as&#41; foi documentada TV em apenas 4&#44;6&#37; doentes &#40;sustentada em 0&#44;8&#37;&#41;&#44; ao longo de um seguimento m&#233;dio de quatro anos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; Por outro lado&#44; a morte s&#250;bita card&#237;aca &#233; uma das principais causas de morte na NCIVE&#44; ocorrendo em at&#233; 18&#37; dos doentes afetados<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Estes dados suportam a hip&#243;tese de que o mioc&#225;rdio n&#227;o compactado pode constituir um substrato altamente arritmog&#233;nico&#46; Os mecanismos propostos incluem a interrup&#231;&#227;o concomitante do desenvolvimento do sistema de condu&#231;&#227;o ou a isquemia progressiva por hipoperfus&#227;o das trab&#233;culas&#46; Por outro lado&#44; os profundos recessos intertrabeculares podem constituir um substrato para a propaga&#231;&#227;o de circuitos de reentrada subjacentes a zonas de cicatriz<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">A estratifica&#231;&#227;o de risco arr&#237;tmico nestes doentes &#233; extremamente dif&#237;cil&#44; tanto mais que a ocorr&#234;ncia de taquiarritmias ventriculares malignas tem sido demonstrada em doentes com fun&#231;&#227;o ventricular conservada&#46; A monitoriza&#231;&#227;o peri&#243;dica por Holter &#233; &#250;til&#44; mas insuficiente&#46; A prova de esfor&#231;o poder&#225; ser importante&#44; nomeadamente&#44; nos doentes com sintomas sugestivos de arritmia desencadeados pelo esfor&#231;o&#44; embora n&#227;o seja recomendada por rotina pela maioria dos autores&#46; O papel do EEF na abordagem dos doentes com NCIVE &#233;&#44; ainda&#44; pouco claro e n&#227;o se encontra contemplado nas recomenda&#231;&#245;es europeias e americanas para a abordagem de doentes com arritmias ventriculares e preven&#231;&#227;o de morte s&#250;bita card&#237;aca<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&#46; Kobza et al&#46; realizaram um estudo retrospetivo em 12 doentes submetidos a implanta&#231;&#227;o de CDI&#44; dos quais sete tinham sido previamente submetidos a EEF por apresentarem sintomas sugestivos de arritmia ou DV esquerda &#40;nos restantes doentes&#44; a decis&#227;o para a implanta&#231;&#227;o do CDI foi tomada com base na exist&#234;ncia de taquiarritmias ventriculares documentadas&#41;&#46; Estes autores verificaram que os tr&#234;s doentes a quem tinha sido induzida TV sustentada ou fibrilha&#231;&#227;o ventricular &#40;FV&#41; durante o EEF tiveram terapias apropriadas do CDI&#46; Nos restantes quatro doentes&#44; em que a estimula&#231;&#227;o el&#233;trica programada n&#227;o induziu nenhuma arritmia ou induziu TVNS&#44; verificou-se apenas uma terapia apropriada &#40;num doente com TVNS induzida&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#46; Num outro estudo&#44; Steffel et al&#46; analisaram retrospetivamente os resultados de um grupo de 24 doentes com NCIVE submetidos a EEF &#40;segundo o crit&#233;rio do m&#233;dico assistente&#41;&#46; A estimula&#231;&#227;o el&#233;trica programada resultou na indu&#231;&#227;o de TV&#47;FV em quatro doentes e de TVNS em cinco&#46; Durante um seguimento m&#233;dio de cinco anos&#44; registaram-se terapias apropriadas do CDI em tr&#234;s dos nove doentes com arritmias indut&#237;veis no EEF &#40;2 com indu&#231;&#227;o de TV&#47;FV e um com indu&#231;&#227;o de TVNS&#41;&#46; Nos 15 doentes em o EEF foi negativo&#44; n&#227;o foram observados epis&#243;dios de taquiarritmia ventricular ou morte s&#250;bita card&#237;aca&#44; apesar de o tempo de seguimento ser inferior &#40;2&#44;5 anos em m&#233;dia&#41; e de se terem perdido tr&#234;s doentes&#46; Face a estes resultados&#44; os autores sugerem que um EEF negativo poder&#225; identificar os doentes com baixo risco de desenvolverem taquiarritmias ventriculares malignas&#44; embora as limita&#231;&#245;es do estudo &#40;reduzido n&#250;mero de doentes e tempo de seguimento desigual nos 2 grupos&#41; n&#227;o permitam extrair conclus&#245;es acerca do valor preditivo negativo do EEF nos doentes com NCIVE&#46; De referir&#44; ainda&#44; que estes autores n&#227;o encontraram nenhuma caracter&#237;stica cl&#237;nica&#44; eletrocardiogr&#225;fica ou ecocardiogr&#225;fica que fosse preditiva da indutibilidade de taquiarritmias ventriculares no EEF<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Na nossa s&#233;rie&#44; apenas cinco doentes foram submetidos a EEF&#44; com indu&#231;&#227;o de TV polim&#243;rfica sincopal em dois casos&#46; O protocolo de estimula&#231;&#227;o el&#233;trica utilizado foi deliberadamente pouco agressivo no sentido de selecionar os doentes com baixo limiar de indu&#231;&#227;o de taquiarritmias&#46; Foi implantado um CDI em quatro doentes&#44; tendo sido documentada uma terapia apropriada apenas no doente tratado em preven&#231;&#227;o secund&#225;ria&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">No estudo de Kobza&#44; foram observadas terapias apropriadas em 50&#37; dos doentes tratados em preven&#231;&#227;o secund&#225;ria e em 25&#37; dos doentes tratados em preven&#231;&#227;o prim&#225;ria<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#46; Num estudo mais recente englobando 44 doentes com NCIVE portadores de CDI&#44; Caliskan et al&#46; registaram terapias apropriadas em 33&#37; dos doentes tratados em preven&#231;&#227;o secund&#225;ria e em 13&#37; dos doentes tratados em preven&#231;&#227;o prim&#225;ria<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">No estado atual do conhecimento&#44; e apesar de as recomenda&#231;&#245;es mais recentes permitirem a implanta&#231;&#227;o de CDI em preven&#231;&#227;o prim&#225;ria em doentes com NCIVE &#40;indica&#231;&#227;o classe IIb&#44; n&#237;vel de evid&#234;ncia C&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#44; a maioria dos autores preconiza que sejam seguidas as recomenda&#231;&#245;es atuais de preven&#231;&#227;o prim&#225;ria e secund&#225;ria estabelecidas para as cardiomiopatias n&#227;o isqu&#233;micas<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">O tratamento da insufici&#234;ncia card&#237;aca segue tamb&#233;m as recomenda&#231;&#245;es atuais&#46; Em casos de DV esquerda grave e bloqueio de ramo esquerdo&#44; deve ser considerada terapia de ressincroniza&#231;&#227;o card&#237;aca &#40;CRT&#41;&#46; Um estudo recente comparando a contrarremodela&#231;&#227;o ventricular ap&#243;s CRT em doentes com NCIVE e doentes com CMD revelou que&#44; no grupo da NCIVE&#44; a percentagem de super-respondedores era significativamente maior e que o grau de contrarremodela&#231;&#227;o ventricular era tanto maior quanto mais extensa a &#225;rea de n&#227;o compacta&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&#46; O transplante card&#237;aco deve ser considerado nos doentes com insufici&#234;ncia card&#237;aca refrat&#225;ria&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Outro aspeto importante no tratamento destes doentes &#233; a preven&#231;&#227;o do tromboembolismo&#46; Na NCIVE&#44; a presen&#231;a de recessos intertrabeculares profundos parece favorecer a estase de sangue com a consequente forma&#231;&#227;o de trombos intraventriculares&#46; As primeiras s&#233;ries publicadas descreviam uma elevada preval&#234;ncia de eventos tromboemb&#243;licos &#40;24 a 38&#37;&#41;&#44; o que levou os seus autores a preconizarem hipocoagula&#231;&#227;o oral para todos os doentes com NCIVE<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;15</span></a>&#46; Por&#233;m&#44; as s&#233;ries mais recentes registam uma taxa muito menor de tromboembolismo &#40;4 a 9&#37;&#41;&#44; o que tamb&#233;m poder&#225; estar relacionado com o maior n&#250;mero de doentes hipocoagulados destas s&#233;ries &#40;at&#233; 60&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;29</span></a>&#46; Atualmente&#44; a maioria dos autores recomenda a hipocoagula&#231;&#227;o oral apenas para os doentes com DV esquerda grave&#44; fibrilha&#231;&#227;o auricular&#44; trombos intraventriculares ou hist&#243;ria de tromboembolismo sist&#233;mico<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;46&#44;47</span></a>&#46; Na nossa s&#233;rie&#44; n&#227;o se verificaram eventos tromboemb&#243;licos nem foram encontrados trombos intraventriculares&#46; Todos os doentes com depress&#227;o moderada a grave da fun&#231;&#227;o sist&#243;lica ou fibrilha&#231;&#227;o auricular foram hipocoagulados&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">O progn&#243;stico dos doentes com NCIVE n&#227;o &#233;&#44; ainda&#44; muito claro&#46; Numa das primeiras s&#233;ries publicadas&#44; Oechslin descreve uma taxa de morte ou transplante de 47&#37; aos 44 meses<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; J&#225; Murphy et al&#46; descrevem uma mortalidade de 2&#37; aos 46 meses<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; O progn&#243;stico mais favor&#225;vel reportado nas s&#233;ries mais recentes poder&#225; estar relacionado com o estabelecimento de terap&#234;uticas mais agressivas nos doentes com insufici&#234;ncia card&#237;aca&#44; arritmias e tromboembolismo&#46; Por outro lado&#44; o maior conhecimento da NCIVE por parte da comunidade m&#233;dica&#44; assim como a melhoria das t&#233;cnicas de imagem&#44; resultaram no diagn&#243;stico de um espectro mais alargado de doentes com NCIVE&#44; incluindo doentes assintom&#225;ticos&#44; n&#227;o inclu&#237;dos nas s&#233;ries iniciais<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; T&#234;m sido considerados fatores de mau progn&#243;stico os seguintes&#58; maior di&#226;metro diast&#243;lico do VE na primeira avalia&#231;&#227;o&#44; insufici&#234;ncia card&#237;aca classe <span class="elsevierStyleSmallCaps">iii</span> ou <span class="elsevierStyleSmallCaps">iv</span> de NYHA&#44; fibrilha&#231;&#227;o auricular permanente e bloqueio de ramo esquerdo<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Os doentes com estes fatores de alto risco dever&#227;o ser candidatos a uma estrat&#233;gia terap&#234;utica mais agressiva&#44; incluindo considera&#231;&#227;o para implanta&#231;&#227;o de CDI e avalia&#231;&#227;o para transplante&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="par0275" class="elsevierStylePara elsevierViewall">Apesar de se tratar de uma cardiomiopatia rara&#44; temos assistido nos &#250;ltimos anos a um crescimento exponencial do n&#250;mero de trabalhos publicados na literatura acerca da NCIVE&#46; Contudo&#44; o conhecimento da verdadeira hist&#243;ria natural desta cardiomiopatia tem sido dificultado pela aus&#234;ncia de grandes s&#233;ries de doentes com seguimento prolongado&#46; Por outro lado&#44; a utiliza&#231;&#227;o de diferentes crit&#233;rios de diagn&#243;stico e a ado&#231;&#227;o de diferentes atitudes terap&#234;uticas tamb&#233;m contribuem para a diferen&#231;a de resultados observada entre as s&#233;ries publicadas&#46; A cria&#231;&#227;o de um registo internacional poder&#225; facilitar a conflu&#234;ncia de informa&#231;&#245;es com vista ao estabelecimento de recomenda&#231;&#245;es universais para o diagn&#243;stico e tratamento destes doentes&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Em resumo&#44; e &#224; luz do conhecimento atual&#44; a NCIVE &#233; uma cardiomiopatia rara cujas principais manifesta&#231;&#245;es cl&#237;nicas s&#227;o a insufici&#234;ncia card&#237;aca&#44; as arritmias e o tromboembolismo&#46; O diagn&#243;stico tem sido tradicionalmente estabelecido por ecocardiografia&#44; embora a RMN esteja a ser cada vez mais utilizada&#46; O progn&#243;stico da NCIVE avan&#231;ada &#233; adverso&#44; mas poder&#225; ser melhorado pelo diagn&#243;stico precoce&#44; rastreio sistem&#225;tico das fam&#237;lias afetadas e estrat&#233;gias terap&#234;uticas agressivas nos doentes de alto risco&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Responsabilidades &#233;ticas</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prote&#231;&#227;o de pessoas e animais</span><p id="par0285" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidencialidade dos dados</span><p id="par0290" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos de seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Direito &#224; privacidade e consentimento escrito</span><p id="par0295" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47;ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflito de interesses</span><p id="par0300" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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          "titulo" => "Discuss&#227;o"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclus&#245;es"
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        9 => array:3 [
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          "titulo" => "Responsabilidades &#233;ticas"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Prote&#231;&#227;o de pessoas e animais"
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            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Confidencialidade dos dados"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Direito &#224; privacidade e consentimento escrito"
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        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflito de interesses"
        ]
        11 => array:1 [
          "titulo" => "Bibliografia"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-02-21"
    "fechaAceptado" => "2012-06-18"
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      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec238235"
          "palabras" => array:5 [
            0 => "N&#227;o compacta&#231;&#227;o isolada do ventr&#237;culo esquerdo"
            1 => "Cardiomiopatia"
            2 => "Diagn&#243;stico"
            3 => "Terap&#234;utica"
            4 => "Progn&#243;stico"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec238236"
          "palabras" => array:5 [
            0 => "Isolated left ventricular noncompaction"
            1 => "Cardiomyopathy"
            2 => "Diagnosis"
            3 => "Therapy"
            4 => "Prognosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A n&#227;o compacta&#231;&#227;o isolada do ventr&#237;culo esquerdo &#40;NCIVE&#41; &#233; uma cardiomiopatia rara&#44; caracterizada pela presen&#231;a de trabecula&#231;&#245;es mioc&#225;rdicas proeminentes e recessos intertrabeculares profundos que comunicam com a cavidade ventricular&#46; A exist&#234;ncia de diferentes crit&#233;rios de diagn&#243;stico&#44; bem como a aus&#234;ncia de recomenda&#231;&#245;es consensuais relativas &#224; sua terap&#234;utica&#44; t&#234;m contribu&#237;do para que sejam descritas s&#233;ries de doentes com caracter&#237;sticas cl&#237;nicas e progn&#243;sticos distintos&#44; o que dificulta o reconhecimento da verdadeira hist&#243;ria natural desta patologia&#46; Este trabalho tem por objetivo contribuir para a caracteriza&#231;&#227;o da NCIVE&#44; atrav&#233;s da descri&#231;&#227;o de uma popula&#231;&#227;o afetada&#44; no que se refere &#224; sua apresenta&#231;&#227;o cl&#237;nica&#44; diagn&#243;stico&#44; estratifica&#231;&#227;o de risco&#44; terap&#234;utica institu&#237;da e seguimento&#46; A prop&#243;sito da revis&#227;o dos casos&#44; &#233; feita uma discuss&#227;o da literatura atual mais relevante acerca do tema&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Isolated left ventricular noncompaction &#40;LVNC&#41; is a rare cardiomyopathy characterized by excessive and prominent trabeculations associated with deep recesses that communicate with the ventricular cavity&#46; Determining the natural history of this condition has been hampered by differences in clinical features and prognosis in published series&#44; which are partly the result of differing diagnostic criteria and the lack of management guidelines&#46; This work aims to contribute to the characterization of isolated LVNC by analyzing an affected population in terms of clinical presentation&#44; diagnosis&#44; risk stratification&#44; treatment and follow-up&#46; We also discuss the most relevant data from the literature concerning this cardiomyopathy&#46;</p>"
      ]
    ]
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imagens de ecocardiograma bidimensional de um doente com NCIVE &#40;em cima&#44; paraesternal eixo longo e eixo curto&#59; em baixo&#44; apical 4 c&#226;maras e apical eixo longo&#41;&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Imagens de RMN card&#237;aca de um doente com NCIVE &#40;eixo curto &#224; esquerda e eixo longo 2 c&#226;maras &#224; direita&#44; sequ&#234;ncia CINE&#41;&#46;</p>"
        ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">D&#58; doente&#59; F&#58; feminino&#59; FA&#58; fibrilha&#231;&#227;o auricular&#59; IC&#58; insufici&#234;ncia card&#237;aca&#59; M&#58; masculino&#59; TVS&#58; taquicardia ventricular sustentada&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Idade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ra&#231;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Indica&#231;&#227;o para ecocardiograma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dismorfias faciais&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Forma familiar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">32&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">M&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">Caucasiana&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">Dor tor&#225;cica&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">Sim&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">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">34&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">F&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">Caucasiana&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">Palpita&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#227;o&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">Caucasiana&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">Rastreio familiar&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">Sim&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">Sim &#40;pai de D1&#41;&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">N&#227;o&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">IC &#40;classe <span class="elsevierStyleSmallCaps">iii</span>&#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">N&#227;o&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  " align="left" valign="\n
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                  \t\t\t\t">Avalia&#231;&#227;o m&#233;dico-desportiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caucasiana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IC &#40;classe <span class="elsevierStyleSmallCaps">ii</span>&#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">N&#227;o&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&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">M&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">Caucasiana&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">Palpita&#231;&#245;es &#40;FA parox&#237;stica&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">57&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">F&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">Caucasiana&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">IC &#40;classe <span class="elsevierStyleSmallCaps">ii</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AE&#58; di&#226;metro da aur&#237;cula esquerda&#59; D&#58; doente&#59; FE&#58; fra&#231;&#227;o de eje&#231;&#227;o&#59; PPVE&#58; espessura da parede posterior do ventr&#237;culo esquerdo&#59; SC&#58; superf&#237;cie corporal&#59; SIV&#58; espessura do septo interventricular&#59; VE td&#58; di&#226;metro telediast&#243;lico do ventr&#237;culo esquerdo&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">D&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" style="border-bottom: 2px solid black">SC&#40;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">AE&#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">AE&#40;mm&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">SIV&#40;mm&#41;&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" style="border-bottom: 2px solid black">PPVE&#40;mm&#41;&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" style="border-bottom: 2px solid black">VE td&#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">VE td&#40;mm&#47;m<span class="elsevierStyleSup">2</span>&#41;&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" style="border-bottom: 2px solid black">&#193;rea de trabecula&#231;&#227;o &#40;paredes&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posterior&#44; inferior e &#225;pex&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lateral e &#225;pex&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</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;pex&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</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posterior e &#225;pex&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</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posterior&#44; lateral e &#225;pex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;pex&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">&#193;pex&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">40&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">Posterior&#44; lateral e &#225;pex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&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\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posterior&#44; lateral e &#225;pex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&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">&#193;pex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab354870.png"
              ]
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas ecocardiogr&#225;ficas da popula&#231;&#227;o</p>"
        ]
      ]
      4 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AIRV&#58; altera&#231;&#245;es inespec&#237;ficas da repolariza&#231;&#227;o ventricular&#59; BAV 1&#46;&#176;G&#58; bloqueio auriculoventricular de 1&#46;&#176; grau&#59; BCRE&#58; bloqueio completo de ramo esquerdo&#59; BFAE&#58; bloqueio do fasc&#237;culo anterior esquerdo&#59; CDI&#58; cardiodesfibrilhador implant&#225;vel&#59; D&#58; doente&#59; ECG&#58; eletrocardiograma&#59; EEF&#58; estudo eletrofisiol&#243;gico&#59; ESV&#58; extrass&#237;stoles supraventriculares&#59; EV&#58; extrass&#237;stoles ventriculares&#59; FAP&#58; fibrilha&#231;&#227;o auricular parox&#237;stica&#59; FE&#58; fra&#231;&#227;o de eje&#231;&#227;o&#59; FV&#58; fibrilha&#231;&#227;o ventricular&#59; HVE&#58; crit&#233;rios de hipertrofia ventricular esquerda&#59; PCP&#58; prova cardiopulmonar&#59; PE&#58; prova de esfor&#231;o&#59; RMN &#40;RT&#41;&#58; realce tardio com <span class="elsevierStyleItalic">gadolinium</span> na resson&#226;ncia magn&#233;tica nuclear&#59; RS&#58; ritmo sinusal&#59; TVS&#58; taquicardia ventricular sustentada&#59; TVNS&#58; taquicardia ventricular n&#227;o sustentada&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ncope&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RMN &#40;RT&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Holter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PE&#47;PCP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EEF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CDI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Seguimento</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TVS&#47;FV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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">N&#227;o&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">N&#227;o&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">RS&#44; HVE&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">Sem arritmias&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">Sem arritmias&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">Indu&#231;&#227;ode TVS&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">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&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">N&#227;o&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">N&#227;o&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">RS&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">Sem arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&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">N&#227;o&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">N&#227;o&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">RS&#44; AIRV&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">TVNS&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">Sem arritmias&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">Sem arritmias&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&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">N&#227;o&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">Sim&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">RS&#44; ondasQ inferiores&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">TVNS&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">Sem arritmias&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">Sem arritmias&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&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">Sim&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">N&#227;o&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">RS&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">Sem arritmias&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">TVS&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">Indu&#231;&#227;ode TVS&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">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;TVS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&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">N&#227;o&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">Sim&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">RS&#44; BFAE&#44; BAV 1&#46;&#176;G&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">Sem arritmias&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">Sem arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&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">N&#227;o&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">N&#227;o&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">RS&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">Sem arritmias&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">Sem arritmias&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">Sem arritmias&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&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">N&#227;o&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">N&#227;o&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">RS&#44; BCRE&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">Sem arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&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">N&#227;o&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">RS&#44; BFAE&#44; EV e ESV&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">FAP&#44;EV&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">Sem arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&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">N&#227;o&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">N&#227;o&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">RS&#44; BCRE&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">EV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  """
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracteriza&#231;&#227;o da popula&#231;&#227;o do ponto de vista arr&#237;tmico</p>"
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                          "etal" => false
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                          "etal" => false
                          "autores" => array:2 [
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;K&#46; Chin"
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                      "Revista" => array:6 [
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                      "titulo" => "Xq28-linked noncompaction of the left ventricular myocardium&#58; prenatal diagnosis and pathologic analysis of affected individuals"
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                        0 => array:2 [
                          "etal" => true
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                    0 => array:1 [
                      "Revista" => array:6 [
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                            0 => "J&#46; Finsterer"
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                    0 => array:2 [
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                          "etal" => false
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                            0 => "J&#46; Finsterer"
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                          "etal" => false
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Richardson"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
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            13 => array:3 [
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              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary definitions and classification of the cardiomyopathies&#58; an American Heart Association Scientific Statement from the Council on Clinical Cardiology&#44; Heart Failure and Transplantation Committee&#59; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups&#59; and Council on Epidemiology and Prevention"
                      "autores" => array:1 [
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