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imagiol&#243;gicas e progn&#243;sticas numa popula&#231;&#227;o portuguesa de doentes com MCH&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Popula&#231;&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">An&#225;lise retrospetiva de doentes com MCH seguidos regularmente em consulta externa de cardiologia num hospital central&#44; que realizaram RMC com estudo de RT&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foram identificados 78 doentes com o diagn&#243;stico ecocardiogr&#225;fico de MCH&#44; destes 61 realizaram RMC&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os motivos para a n&#227;o realiza&#231;&#227;o de RMC foram os crit&#233;rios cl&#225;ssicos que impedem a realiza&#231;&#227;o deste exame &#40;por exemplo&#44; portador de CDI&#44; <span class="elsevierStyleItalic">pacemaker</span>&#44; claustrofobia&#41; ou a recusa do doente&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A defini&#231;&#227;o de MCH baseou&#8208;se nos crit&#233;rios cl&#225;ssicos ecocardiogr&#225;ficos &#40;ventr&#237;culo hipertrofiado&#44; n&#227;o dilatado e com uma espessura m&#225;xima da parede &#8805;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm&#41; e na demonstra&#231;&#227;o da aus&#234;ncia de outra causa sist&#233;mica ou local de hipertrofia&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos cinco doentes nos quais n&#227;o foi poss&#237;vel realizar o estudo de RT&#44; uma doente com o diagn&#243;stico de amiloidose card&#237;aca e duas doentes com s&#237;ndrome de Noonan&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O grupo final de estudo incluiu 53 doentes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dados cl&#237;nicos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Colhidos dos registos m&#233;dicos dos doentes por um investigador cego para os resultados da RMC&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas de base</span><p id="par0060" class="elsevierStylePara elsevierViewall">Foram colhidas as seguintes caracter&#237;sticas de base&#58; hipertens&#227;o arterial&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; s&#237;ndrome de apneia obstrutiva do sono&#44; doen&#231;a coron&#225;ria&#44; fibrilha&#231;&#227;o auricular&#44; s&#237;ncope&#44; antecedentes de morte s&#250;bita num familiar de primeiro grau &#40;&#60;<span class="elsevierStyleHsp" style=""></span>45 anos&#41;&#44; classe funcional da <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; medica&#231;&#227;o com beta&#8208;bloqueante ou antagonista dos canais de c&#225;lcio n&#227;o dihidropirid&#237;nico&#44; realiza&#231;&#227;o de miectomia ou abla&#231;&#227;o septal com &#225;lcool&#44; portador de <span class="elsevierStyleItalic">pacemaker</span> ou de CDI&#44; eletrocardiograma em repouso e valor de NT&#8208;pro&#8208;BNP&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O rastreio da doen&#231;a de Anderson&#8208;Fabry foi feito em 34 &#40;64&#44;1&#37;&#41; doentes e a pesquisa de muta&#231;&#227;o cl&#225;ssica para MCH em 41 &#40;77&#44;4&#37;&#41; doentes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Avalia&#231;&#227;o de resposta tensional na prova de esfor&#231;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">A prova de esfor&#231;o segundo o protocolo de Bruce modificado foi realizada em 30 &#40;56&#44;6&#37;&#41; doentes&#46; Uma resposta hipotensiva foi definida como a aus&#234;ncia de aumento da press&#227;o arterial em 20<span class="elsevierStyleHsp" style=""></span>mmHg ou uma descida de pelo menos 20<span class="elsevierStyleHsp" style=""></span>mmHg durante o esfor&#231;o&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Par&#226;metros ecocardiogr&#225;ficos</span><p id="par0075" class="elsevierStylePara elsevierViewall">O ecocardiograma transtor&#225;cico foi realizado por dois observadores experientes que desconheciam em parte a informa&#231;&#227;o cl&#237;nica dos doentes&#46; Foram avaliados os seguintes par&#226;metros&#58; di&#226;metro diast&#243;lico do ventr&#237;culo esquerdo&#59; espessura do septo interventricular&#44; parede posterior e &#225;pex&#59; volume indexado da aur&#237;cula esquerda&#59; presen&#231;a de gradiente &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mmHg&#41; em repouso e ap&#243;s manobra provocativa&#59; quantifica&#231;&#227;o de insufici&#234;ncia mitral&#59; classifica&#231;&#227;o da fun&#231;&#227;o sist&#243;lica e disfun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Treze dos doentes sem gradiente em repouso &#40;33&#44;4&#37;&#41; realizaram ecocardiograma de esfor&#231;o para avalia&#231;&#227;o da presen&#231;a de gradiente com o exerc&#237;cio&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resson&#226;ncia magn&#233;tica card&#237;aca</span><p id="par0085" class="elsevierStylePara elsevierViewall">Todos os estudos foram realizados num <span class="elsevierStyleItalic">scanner</span> de resson&#226;ncia magn&#233;tica 1&#46;5 Tesla <span class="elsevierStyleItalic">&#40;Phillips</span>&#174;<span class="elsevierStyleItalic">&#41;</span>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A RMC foi realizada por tr&#234;s observadores experientes que desconheciam em parte a informa&#231;&#227;o cl&#237;nica dos doentes&#46; Foram avaliados os seguintes par&#226;metros&#58; &#225;rea da aur&#237;cula esquerda&#59; fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;FEVE&#41;&#59; maior espessura da parede ventricular&#59; presen&#231;a de realce tardio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">As imagens de realce tardio foram adquiridas ap&#243;s administra&#231;&#227;o de gadol&#237;nio endovenoso&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Seguimento cl&#237;nico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Os doentes foram seguidos durante um per&#237;odo m&#233;dio de 53&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#44;4 meses &#40;entre 4&#8208;271 meses&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Todos os doentes realizaram Holter das 24 horas&#44; permitindo a identifica&#231;&#227;o do n&#250;mero de extrass&#237;stoles ventriculares nesse per&#237;odo&#44; bem como de epis&#243;dios de taquicardia ventricular n&#227;o mantida&#44; definida como a presen&#231;a de tr&#234;s ou mais complexos ventriculares consecutivos&#44; com menos de 30 segundos de dura&#231;&#227;o e sem compromisso hemodin&#226;mico&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nos doentes portadores de CDI foi feita pesquisa referente a todas as consultas de seguimento do dispositivo e foram consideradas terapias apropriadas as descargas de CDI e as terapias antitaquicardia &#40;por <span class="elsevierStyleItalic">overdrive pacing</span>&#41; desencadeadas por fibrila&#231;&#227;o ventricular e&#47;ou taquicardia ventricular&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Foram definidos dois <span class="elsevierStyleItalic">endpoints</span>&#58; mortalidade por qualquer causa e terapias apropriadas de CDI&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lise estat&#237;stica</span><p id="par0120" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com SPSS para Windows&#44; vers&#227;o 17&#46;0&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As vari&#225;veis nominais foram expressas como contagens e percentagens&#46; Foi feita compara&#231;&#227;o de vari&#225;veis nominais &#40;combina&#231;&#227;o de frequ&#234;ncias&#41; com teste &#967;<span class="elsevierStyleSup">2</span>&#46; As vari&#225;veis cont&#237;nuas foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio&#8208;padr&#227;o&#44; aplicou&#8208;se o teste T de Student para comparar vari&#225;veis com distribui&#231;&#227;o normal e o teste Mann&#8208;Whitney U para comparar vari&#225;veis que n&#227;o respeitam uma distribui&#231;&#227;o normal&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Um valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significativo&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Caracter&#237;sticas da popula&#231;&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o do estudo consistiu em 53 doentes&#58; 27 &#40;50&#44;9&#37;&#41; do sexo masculino&#44; com uma idade de 56&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;0 anos &#224; data do diagn&#243;stico&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a> mostra as principais caracter&#237;sticas da popula&#231;&#227;o&#46; Relativamente &#224; capacidade funcional&#44; de acordo com a classifica&#231;&#227;o da NYHA&#58; 29 &#40;54&#44;7&#37;&#41; dos doentes estava em NYHA I&#59; 22 &#40;41&#44;5&#37;&#41; em NYHA <span class="elsevierStyleSmallCaps">II</span> e dois &#40;3&#44;8&#37;&#41; em NYHA III&#46; Nenhum doente foi submetido a miectomia e a realiza&#231;&#227;o de abla&#231;&#227;o septal com &#225;lcool foi feita em dois doentes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a> descreve as principais altera&#231;&#245;es eletrocardiogr&#225;ficas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Dos 34 &#40;64&#44;1&#37;&#41; doentes rastreados para doen&#231;a de Anderson&#8208;Fabry em nenhum foi encontrada uma muta&#231;&#227;o cl&#225;ssica&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A pesquisa de muta&#231;&#227;o das prote&#237;nas do sarc&#243;mero feita em 41 &#40;77&#44;4&#37;&#41; doentes foi negativa em 12 &#40;29&#44;3&#37;&#41;&#59; em nove &#40;21&#44;9&#37;&#41; foi identificada uma muta&#231;&#227;o cl&#225;ssica&#59; em tr&#234;s &#40;7&#44;3&#37;&#41; uma muta&#231;&#227;o de significado indeterminado e 17 &#40;41&#44;5&#37;&#41; aguardam ainda o resultado do estudo&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">O valor m&#233;dio de NT&#8208;pro&#8208;BNP avaliado em 29 &#40;54&#44;7&#37;&#41; doentes foi de 3&#46;130<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;762<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Apenas quatro &#40;13&#44;3&#37;&#41; dos doentes que realizaram prova de esfor&#231;o desenvolveram uma resposta hipotensiva&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Caracteriza&#231;&#227;o dos achados ecocardiogr&#225;ficos da popula&#231;&#227;o</span><p id="par0170" class="elsevierStylePara elsevierViewall">A distribui&#231;&#227;o fenot&#237;pica da MCH foi a seguinte&#58; assim&#233;trica em 36 &#40;67&#44;9&#37;&#41; doentes&#59; apical em 13 &#40;24&#44;5&#37;&#41; e conc&#234;ntrica em quatro &#40;7&#44;5&#37;&#41;&#46; A presen&#231;a de movimento sist&#243;lico anterior da v&#225;lvula mitral condicionando obstru&#231;&#227;o em repouso foi objetivada em 20 &#40;37&#44;7&#37;&#41; doentes&#44; com um gradiente telessist&#243;lico de 69&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Quanto &#224; presen&#231;a e gravidade da insufici&#234;ncia mitral&#58; ausente em seis &#40;11&#44;3&#37;&#41; doentes&#59; m&#237;nima &#40;grau 1&#41; em 30 &#40;56&#44;6&#37;&#41;&#59; ligeira &#40;grau 2&#41; em 11 &#40;20&#44;8&#37;&#41;&#59; moderada &#40;grau 3&#41; em cinco &#40;9&#44;4&#37;&#41; e severa &#40;grau 4&#41; num doente &#40;1&#44;9&#37;&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Apenas sete &#40;13&#44;2&#37;&#41; doentes n&#227;o apresentavam disfun&#231;&#227;o diast&#243;lica&#59; sendo o padr&#227;o pseudonormal o mais frequente&#44; presente em 22 &#40;41&#44;5&#37;&#41; doentes&#59; seguido da altera&#231;&#227;o do relaxamento em 21 &#40;39&#44;6&#37;&#41; doentes&#59; com tr&#234;s &#40;5&#44;7&#37;&#41; doentes apresentando um padr&#227;o restritivo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Um compromisso pelo menos ligeiro da fun&#231;&#227;o sist&#243;lica global foi identificado em sete &#40;13&#44;2&#37;&#41; doentes&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a> mostra as principais vari&#225;veis cont&#237;nuas ecocardiogr&#225;ficas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Dos 13 doentes que realizaram ecocardiograma de esfor&#231;o&#44; sete &#40;53&#44;8&#37;&#41; apresentaram desenvolvimento de gradiente significativo com o exerc&#237;cio &#40;69&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#44;9<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Caracteriza&#231;&#227;o dos achados da resson&#226;ncia magn&#233;tica card&#237;aca da popula&#231;&#227;o</span><p id="par0195" class="elsevierStylePara elsevierViewall">A caracteriza&#231;&#227;o fenot&#237;pica da MCH foi semelhante &#224; previamente identificada por ecocardiograma transtor&#225;cico&#44; permitindo&#44; contudo&#44; definir melhor a localiza&#231;&#227;o da hipertrofia ventricular&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a> mostra as principais vari&#225;veis cont&#237;nuas avaliadas na RMC&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">A presen&#231;a de realce tardio foi identificada em 24 &#40;45&#44;3&#37;&#41; doentes&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Fatores preditores da presen&#231;a de realce tardio na resson&#226;ncia magn&#233;tica card&#237;aca</span><p id="par0210" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de MCH foi feito numa idade mais jovem nos doentes com RT na RMC &#40;52&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;9 <span class="elsevierStyleItalic">versus</span> 59&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; e mais frequentemente estes doentes apresentavam uma hist&#243;ria familiar de morte s&#250;bita &#40;33&#44;3 <span class="elsevierStyleItalic">versus</span> 3&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#59; OR 13&#44;5&#41;&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Observou&#8208;se uma tend&#234;ncia para os doentes com RT na RMC mais frequentemente apresentarem antecedentes de doen&#231;a coron&#225;ria &#40;12&#44;5 <span class="elsevierStyleItalic">versus</span> 0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;086&#41; e valores mais elevados de NT&#8208;pro&#8208;BNP &#40;5&#46;151<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;882 <span class="elsevierStyleItalic">versus</span> 1&#46;489<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;422&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;089&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Quanto &#224;s restantes caracter&#237;sticas cl&#237;nicas n&#227;o houve diferen&#231;as entre os grupos em rela&#231;&#227;o a sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;669&#41;&#59; antecedentes de hipertens&#227;o arterial &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;899&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;532&#41; ou s&#237;ndrome de apneia obstrutiva do sono &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;135&#41;&#59; presen&#231;a de muta&#231;&#227;o identificada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;676&#41;&#59; antecedentes de s&#237;ncope &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;288&#41;&#59; classe funcional da NYHA&#59; medica&#231;&#227;o pr&#233;via com beta&#8208;bloqueante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;454&#41; ou antagonista dos canais de c&#225;lcio n&#227;o dihidropirid&#237;nico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;112&#41;&#59; crit&#233;rios de voltagem de HVE no eletrocardiograma &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;696&#41;&#59; antecedentes de fibrilha&#231;&#227;o auricular &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;098&#41;&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">N&#227;o foram observadas diferen&#231;as entre os grupos na resposta tensional na prova de esfor&#231;o &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;348&#41;&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nas vari&#225;veis ecocardiogr&#225;ficas&#44; os doentes com realce tardio mais frequentemente apresentavam disfun&#231;&#227;o sist&#243;lica&#44; caracterizada por uma FEVE inferior a 50&#37; &#40;25&#44;0 <span class="elsevierStyleItalic">versus</span> 3&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#59; OR 9&#44;33&#41; e disfun&#231;&#227;o diast&#243;lica com padr&#227;o pseudonormal &#40;68&#44;2 <span class="elsevierStyleItalic">versus</span> 29&#44;2&#37;&#41; ou restritivo &#40;9&#44;1 <span class="elsevierStyleItalic">versus</span> 4&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a> mostra as vari&#225;veis ecocardiogr&#225;ficas cont&#237;nuas preditoras de realce tardio na RMC&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">N&#227;o foi observada qualquer associa&#231;&#227;o entre o tipo de MCH e a presen&#231;a de RT&#58; MCH assim&#233;trica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;441&#41;&#59; MCH apical &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;475&#41; ou MCH conc&#234;ntrica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;844&#41;&#46; Do mesmo modo&#44; nem a presen&#231;a de obstru&#231;&#227;o &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;242&#41; ou a gravidade da insufici&#234;ncia mitral &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;637&#41; se associaram a RT&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a> mostra as vari&#225;veis da RMC preditoras de RT&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Seguimento cl&#237;nico</span><p id="par0250" class="elsevierStylePara elsevierViewall">Os doentes foram seguidos durante um per&#237;odo m&#233;dio de 53&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#44;4 meses &#40;entre 4&#8208;271 meses&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;as entre os grupos na dete&#231;&#227;o de taquicardia ventricular n&#227;o mantida em Holter de 24 horas &#40;20&#44;8 <span class="elsevierStyleItalic">versus</span> 20&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;990&#41;&#44; bem como no n&#250;mero de extrass&#237;stoles ventriculares documentadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;503&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Durante o seguimento cl&#237;nico foi realizada implanta&#231;&#227;o de CDI em 11 &#40;20&#44;7&#37;&#41; doentes para preven&#231;&#227;o prim&#225;ria com base na presen&#231;a de um ou mais fatores de risco cl&#225;ssicos&#46; A implanta&#231;&#227;o de CDI foi mais frequentemente realizada nos doentes com RT &#40;37&#44;5 <span class="elsevierStyleItalic">versus</span> 6&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; Nos doentes portadores de CDI apenas num foi detetada terapia apropriada com <span class="elsevierStyleItalic">overdrive pacing</span>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Em todo o seguimento cl&#237;nico apenas faleceram dois doentes&#44; um de cada grupo&#44; por insufici&#234;ncia card&#237;aca&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discuss&#227;o</span><p id="par0270" class="elsevierStylePara elsevierViewall">A RMC &#233; a modalidade de imagem preferida para determina&#231;&#227;o da massa ventricular&#44; do volume das cavidades card&#237;acas&#44; da fun&#231;&#227;o sist&#243;lica global e do padr&#227;o e distribui&#231;&#227;o de hipertrofia ventricular em doentes com MCH<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a>&#46; A avalia&#231;&#227;o do RT representa um modo &#250;nico de identificar &#225;reas de fibrose&#44; bem como a sua distribui&#231;&#227;o e quantifica&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Caracter&#237;sticas da popula&#231;&#227;o</span><p id="par0275" class="elsevierStylePara elsevierViewall">A idade m&#233;dia dos nossos doentes &#40;56&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;0 anos&#41; &#233; superior &#224; da maioria dos estudos publicados na literatura<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;11&#44;12</span></a>&#44; englobando poucos doentes na faixa et&#225;ria mais associada &#224; morte s&#250;bita &#40;&#60;<span class="elsevierStyleHsp" style=""></span>35 anos&#41;&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">A maioria dos nossos doentes era assintom&#225;tica ou pouco sintom&#225;tica&#44; tal como em popula&#231;&#245;es j&#225; previamente descritas na literatura<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13&#8211;15</span></a>&#46; Este facto real&#231;a a import&#226;ncia de novas estrat&#233;gias de estratifica&#231;&#227;o de risco de morte s&#250;bita&#44; uma vez que esta poder&#225; ser a primeira manifesta&#231;&#227;o cl&#237;nica da MCH anos ap&#243;s o diagn&#243;stico inicial<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Apesar da MCH assim&#233;trica ser o padr&#227;o mais frequentemente encontrado &#40;67&#44;9&#37;&#41;&#44; &#233; de real&#231;ar a elevada preval&#234;ncia de MCH apicais &#40;24&#44;5&#37;&#41; na nossa popula&#231;&#227;o&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">O facto da m&#233;dia da espessura m&#225;xima da parede ventricular ser de 19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8<span class="elsevierStyleHsp" style=""></span>mm &#40;avalia&#231;&#227;o por RMC&#41; demonstra que a presen&#231;a de hipertrofia ventricular esquerda significativa pode ocorrer em doentes muito pouco sintom&#225;ticos&#44; tal como j&#225; descrito na literatura<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">A presen&#231;a de obstru&#231;&#227;o no trato de sa&#237;da do ventr&#237;culo esquerdo na nossa popula&#231;&#227;o &#40;50&#44;9&#37;&#41; foi inferior &#224; descrita na literatura<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#59; contudo&#44; houve uma percentagem de doentes sem gradiente em repouso que n&#227;o realizaram ecocardiograma de esfor&#231;o&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Do mesmo modo&#44; a percentagem de doentes que desenvolveu uma resposta hipotensiva na prova de esfor&#231;o &#40;13&#44;3&#37;&#41; foi inferior &#224; descrita na literatura &#40;25&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Significado cl&#237;nico e progn&#243;stico do realce tardio</span><p id="par0305" class="elsevierStylePara elsevierViewall">O nosso estudo confirmou que a presen&#231;a de RT &#233; uma caracter&#237;stica fenot&#237;pica frequente nesta popula&#231;&#227;o&#44; tendo&#44; contudo&#44; sido identificado numa percentagem &#40;45&#44;3&#37;&#41; inferior &#224; descrita na literatura<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a>&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">O padr&#227;o de distribui&#231;&#227;o do RT n&#227;o corresponde ao territ&#243;rio de perfus&#227;o das art&#233;rias coron&#225;rias epic&#225;rdicas&#44; mas relaciona&#8208;se com &#225;reas de hipertrofia ventricular&#44; tendo uma localiza&#231;&#227;o mesoc&#225;rdica<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Foram fatores preditores de RT a idade mais jovem&#44; hist&#243;ria familiar de morte s&#250;bita&#44; FEVE inferior a 50&#37;&#44; graus mais graves de disfun&#231;&#227;o diast&#243;lica&#44; maior dilata&#231;&#227;o da aur&#237;cula esquerda e espessura m&#225;xima da parede ventricular esquerda&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">&#201; bem reconhecida a associa&#231;&#227;o inversa entre a presen&#231;a e a extens&#227;o de RT e a FEVE<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44; uma vez que o RT se relaciona com o <span class="elsevierStyleItalic">remodelling</span> ventricular que em &#250;ltima inst&#226;ncia leva &#224; insufici&#234;ncia card&#237;aca<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Do mesmo modo&#44; tamb&#233;m est&#225; descrita na literatura a associa&#231;&#227;o entre RT e a espessura m&#225;xima da parede ventricular esquerda<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">A dilata&#231;&#227;o auricular esquerda&#44; <span class="elsevierStyleItalic">surrogate marker</span> de disfun&#231;&#227;o diast&#243;lica&#44; tamb&#233;m se associou &#224; presen&#231;a de RT<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Apesar da reduzida taxa de mortalidade na nossa popula&#231;&#227;o&#44; importa salientar que a causa foi sempre cardiovascular&#44; neste caso insufici&#234;ncia card&#237;aca&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">Tal como em estudos pr&#233;vios&#44; tamb&#233;m no nosso trabalho o valor progn&#243;stico independente do RT ainda continua por demonstrar<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15</span></a>&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> documentaram uma elevada preval&#234;ncia de eventos cardiovasculares no seguimento cl&#237;nico de 202 doentes com MCH e RT&#44; mas sem significado estat&#237;stico&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Em contrapartida&#44; Bruder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> estudaram 220 doentes com MCH oligosintom&#225;ticos&#44; com um seguimento cl&#237;nico m&#233;dio de tr&#234;s anos&#44; demonstrando que o RT era um preditor independente de mortalidade card&#237;aca &#40;HR 8&#44;6&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41;&#59; enquanto a presen&#231;a de dois ou mais fatores de risco cl&#237;nicos n&#227;o teve significado estat&#237;stico &#40;HR 1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68&#41;&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Recentemente Green et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> realizaram uma meta&#8208;an&#225;lise com quatro estudos&#44; incluindo 1&#46;063 doentes com MCH&#44; confirmando a elevada preval&#234;ncia de RT &#40;60&#37; dos doentes&#41; e a sua associa&#231;&#227;o com eventos cardiovasculares adversos &#40;morte card&#237;aca&#44; morte por insufici&#234;ncia card&#237;aca&#44; mortalidade por todas as causas&#41;&#59; contudo&#44; sem associa&#231;&#227;o com morte s&#250;bita&#47;morte s&#250;bita abortada e sem acrescentar valor aos fatores cl&#237;nicos tradicionais&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Numa popula&#231;&#227;o onde a presen&#231;a de RT ronda os 60&#37; e a taxa de eventos oscila entre 1&#8208;5&#37;&#47;ano&#44; tal rela&#231;&#227;o ser&#225; dif&#237;cil de demonstrar&#46; Assim&#44; torna&#8208;se pertinente o desenvolvimento de t&#233;cnicas mais sofisticadas para quantifica&#231;&#227;o do RT&#44; potenciando provavelmente a utilidade progn&#243;stica desta t&#233;cnica<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; A quantifica&#231;&#227;o da extens&#227;o do RT atrav&#233;s das sequ&#234;ncias ponderadas em T1 j&#225; foi validada noutras doen&#231;as mioc&#225;rdicas &#40;doen&#231;a card&#237;aca isqu&#233;mica e miocardiopatia dilatada&#41;&#44; podendo ser tamb&#233;m uma mais&#8208;valia na MCH<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">O registo europeu de RMC incluiu 249 doentes com MCH&#44; com um seguimento cl&#237;nico atual de 12 meses&#44; observou apenas uma tend&#234;ncia para um melhor progn&#243;stico nos doentes sem RT<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Limita&#231;&#245;es do estudo</span><p id="par0365" class="elsevierStylePara elsevierViewall">O nosso estudo tem v&#225;rias limita&#231;&#245;es come&#231;ando pelo n&#250;mero reduzido de doentes e de eventos&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Doentes portadores de CDI que n&#227;o realizaram RMC previamente &#224; implanta&#231;&#227;o do dispositivo n&#227;o foram inclu&#237;dos no nosso estudo&#44; sendo imposs&#237;vel prever como a inclus&#227;o destes doentes poderia mudar de um modo significativo os resultados&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de quantifica&#231;&#227;o do RT&#44; bem como da caracteriza&#231;&#227;o da sua distribui&#231;&#227;o &#233; outra limita&#231;&#227;o&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Como em qualquer estudo retrospetivo fomos limitados pela informa&#231;&#227;o que se encontra dispon&#237;vel nos ficheiros cl&#237;nicos dos doentes&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclus&#245;es</span><p id="par0385" class="elsevierStylePara elsevierViewall">A presen&#231;a de realce tardio surge como um marcador de risco&#44; associando&#8208;se a fatores j&#225; reconhecidos como preditores de morte s&#250;bita na miocardiopatia hipertr&#243;fica&#44; nomeadamente a hist&#243;ria de morte s&#250;bita na fam&#237;lia e a espessura m&#225;xima da parede ventricular esquerda&#46; A sua associa&#231;&#227;o independente a eventos cl&#237;nicos exige o estudo de popula&#231;&#245;es de maior dimens&#227;o em estudos com maior seguimento cl&#237;nico&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Responsabilidades &#233;ticas</span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Prote&#231;&#227;o de pessoas e animais</span><p id="par0390" 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="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Confidencialidade dos dados</span><p id="par0395" 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="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Direito &#224; privacidade e consentimento escrito</span><p id="par0400" 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="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflito de interesses</span><p id="par0405" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O valor progn&#243;stico do realce tardio na estratifica&#231;&#227;o dos doentes com miocardiopatia hipertr&#243;fica &#233; controverso&#46; Este trabalho pretende avaliar a associa&#231;&#227;o entre a presen&#231;a de realce tardio na resson&#226;ncia magn&#233;tica card&#237;aca e caracter&#237;sticas cl&#237;nicas&#44; imagiol&#243;gicas e progn&#243;sticas em doentes com miocardiopatia hipertr&#243;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">De 78 doentes com miocardiopatia hipertr&#243;fica avali&#225;mos retrospetivamente 53&#44; que realizaram resson&#226;ncia card&#237;aca&#46; Os doentes foram divididos em dois grupos&#44; conforme a presen&#231;a ou aus&#234;ncia de realce tardio&#46; Foi feito seguimento cl&#237;nico referente a disritmia ventricular e a morbi&#8208;mortalidade&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os doentes com realce tardio eram mais jovens &#224; data do diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41;&#44; mais frequentemente tinham antecedentes familiares de morte s&#250;bita &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; e de doen&#231;a coron&#225;ria &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;086&#41;&#46; No ecocardiograma apresentavam maior espessura parietal m&#225;xima &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#59; &#225;rea &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41; e volume indexado da aur&#237;cula esquerda &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#59; maior frequ&#234;ncia de padr&#227;o restritivo de disfun&#231;&#227;o diast&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#44; com rela&#231;&#227;o E&#47;E&#8217; mais elevada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#59; e disfun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41;&#46; A resson&#226;ncia validou as altera&#231;&#245;es ecocardiogr&#225;ficas associadas &#224; presen&#231;a de realce tardio&#58; maior &#225;rea da aur&#237;cula esquerda &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#59; espessura parietal m&#225;xima &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e menor fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;056&#41;&#46; Os doentes com realce tardio mais frequentemente eram portadores de CDI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#59; n&#227;o havendo diferen&#231;as na frequ&#234;ncia de epis&#243;dios de disritmia ventricular&#44; terapias apropriadas de CDI ou mortalidade no seguimento cl&#237;nico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A presen&#231;a de realce tardio surge como um marcador de risco&#44; associando&#8208;se a fatores j&#225; reconhecidos como preditores de morte s&#250;bita nesta popula&#231;&#227;o&#46; A sua associa&#231;&#227;o independente a eventos cl&#237;nicos exige o estudo de popula&#231;&#245;es de maior dimens&#227;o&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction and Aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The prognostic value of late gadolinium enhancement &#40;LGE&#41; for risk stratification of hypertrophic cardiomyopathy &#40;HCM&#41; patients is the subject of disagreement&#46; We set out to examine the association between clinical and morphological variables&#44; risk factors for sudden cardiac death and LGE in HCM patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">From a population of 78 patients with HCM&#44; we studied 53 who underwent cardiac magnetic resonance&#46; They were divided into two groups according to the presence or absence of LGE&#46; Ventricular arrhythmias and morbidity and mortality during follow&#8208;up were analyzed&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Patients with LGE were younger at the time of diagnosis &#40;p&#61;0&#46;046&#41; and more often had a family history of sudden death &#40;p&#61;0&#46;008&#41; and known coronary artery disease &#40;p&#61;0&#46;086&#41;&#46; On echocardiography they had greater maximum wall thickness &#40;p&#61;0&#46;007&#41; and left atrial area &#40;p&#61;0&#46;037&#41; and volume &#40;p&#61;0&#46;035&#41;&#44; and more often presented a restrictive pattern of diastolic dysfunction &#40;p&#61;0&#46;011&#41; with a higher E&#47;E¿ ratio &#40;p&#61;0&#46;003&#41; and left ventricular systolic dysfunction &#40;p&#61;0&#46;038&#41;&#46; Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings&#58; greater left atrial area &#40;p&#61;0&#46;029&#41; and maximum wall thickness &#40;p&#60;0&#46;001&#41; and lower left ventricular ejection fraction &#40;p&#61;0&#46;056&#41;&#46; Patients with LGE more often had an implantable cardioverter&#8208;defibrillator &#40;ICD&#41; &#40;p&#61;0&#46;015&#41;&#46; At follow&#8208;up&#44; no differences were found in the frequency of ventricular arrhythmias&#44; appropriate ICD therapies or mortality&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">The presence of LGE emerges as a risk marker&#44; associated with the classical predictors of sudden cardiac death in this population&#46; However&#44; larger studies are required to confirm its independent association with clinical events&#46;</p>"
      ]
    ]
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ACC&#58; antagonista dos canais de c&#225;lcio&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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">Hipertens&#227;o arterial&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">38 &#40;71&#44;7&#37;&#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">Diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 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">6 &#40;11&#44;3&#37;&#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">S&#237;ndrome de apneia obstrutiva do sono&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">6 &#40;11&#44;3&#37;&#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">Fibrilha&#231;&#227;o auricular&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">16 &#40;30&#44;2&#37;&#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">Antecedentes de doen&#231;a coron&#225;ria&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">3 &#40;5&#44;7&#37;&#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">Antecedentes de s&#237;ncope&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">8 &#40;15&#44;1&#37;&#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">Hist&#243;ria familiar de morte s&#250;bita&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 &#40;17&#44;3&#37;&#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">Medica&#231;&#227;o com beta&#8208;bloqueante&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 &#40;69&#44;8&#37;&#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">Medica&#231;&#227;o com ACC n&#227;o dihidropirid&#237;nico&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">7 &#40;13&#44;2&#37;&#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"><span class="elsevierStyleItalic">Pacemaker</span> definitivo&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">5 &#40;9&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab518331.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Principais caracter&#237;sticas da popula&#231;&#227;o</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BAV&#58; bloqueio auriculoventricular&#59; HVE&#58; hipertrofia ventricular esquerda&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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">Bloqueio completo de ramo direito&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">5 &#40;9&#44;4&#37;&#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">Hemibloqueio anterior esquerdo&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">16 &#40;30&#44;2&#37;&#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">Bloqueio completo de ramo esquerdo&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 &#40;1&#44;9&#37;&#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">Bloqueio bifascicular&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">8 &#40;15&#44;1&#37;&#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">BAV 1&#46;&#176; grau&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 &#40;24&#44;5&#37;&#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">BAV 2&#46;&#176; grau&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">4 &#40;7&#44;5&#37;&#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">BAV 3&#46;&#176; grau&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">3 &#40;5&#44;7&#37;&#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">Crit&#233;rios de voltagem de 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;69&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Principais altera&#231;&#245;es eletrocardiogr&#225;ficas</p>"
        ]
      ]
      2 => array:7 [
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        "etiqueta" => "Tabela 3"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A4C&#58; apical quatro c&#226;maras&#59; AE&#58; aur&#237;cula esquerda&#59; VE&#58; ventr&#237;culo esquerdo&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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">Di&#226;metro diast&#243;lico do VE&#44; mm&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">48&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4&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">Septo interventricular&#44; mm&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&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3&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">Parede posterior&#44; mm&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&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3&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">&#193;pex &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; mm&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&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;4&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">&#193;rea da AE &#40;A4C&#41;&#44; mm<span class="elsevierStyleSup">2</span>&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&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;6&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">Volume indexado da AE&#44; mm<span class="elsevierStyleSup">3</span>&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">52&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;1&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">Velocidade da onda E&#44; m&#47;seg&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">0&#44;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;31&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">E&#8242; lateral&#44; cm&#47;seg&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">6&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4&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">Rela&#231;&#227;o E&#47;E&#8242;&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&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab518328.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Principais vari&#225;veis cont&#237;nuas ecocardiogr&#225;ficas</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AE&#58; aur&#237;cula esquerda&#59; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo&#59; VE&#58; ventr&#237;culo esquerdo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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;rea AE&#44; cm<span class="elsevierStyleSup">2</span>&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&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;78&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">Massa do VE&#44; 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56&#44;4&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">Maior espessura medida&#44; mm&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">19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8&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">FEVE&#44; &#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab518327.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Principais vari&#225;veis cont&#237;nuas avaliadas na resson&#226;ncia magn&#233;tica card&#237;aca</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabela 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">A4C&#58; apical quatro c&#226;maras&#59; AE&#58; aur&#237;cula esquerda&#59; RT&#58; realce tardio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Vari&#225;vel&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">Doentes com RT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#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" style="border-bottom: 2px solid black">Doentes sem RT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#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" style="border-bottom: 2px solid black">p&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">Maior espessura&#44; mm&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&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;08&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">15&#44;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;82&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">0&#44;007&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">&#193;rea AE &#40;A4C&#41;&#44; cm<span class="elsevierStyleSup">2</span>&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">26&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;97&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">23&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;94&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">0&#44;037&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">Volume indexado AE&#44; cm<span class="elsevierStyleSup">3</span>&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&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;77&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&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;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">0&#44;035&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">Rela&#231;&#227;o E&#47;E¿&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">16&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;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">11&#44;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;96&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">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab518329.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Vari&#225;veis ecocardiogr&#225;ficas cont&#237;nuas preditoras de realce tardio na resson&#226;ncia magn&#233;tica card&#237;aca</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabela 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">AE&#58; aur&#237;cula esquerda&#59; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo&#59; RT&#58; realce tardio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Vari&#225;vel&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">Doentes com RT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#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" style="border-bottom: 2px solid black">Doentes sem RT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#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" style="border-bottom: 2px solid black">p&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">Maior espessura&#44; mm&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&#44;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;05&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&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;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
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