que se leu este artigo
array:25 [ "pii" => "S0870255116301901" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.04.012" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "879" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:593-600" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4573 "formatos" => array:3 [ "EPUB" => 238 "HTML" => 3479 "PDF" => 856 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204916302124" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.10.014" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "879" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:593-600" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2444 "formatos" => array:3 [ "EPUB" => 212 "HTML" => 1732 "PDF" => 500 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "600" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Alterações eletrocardiográficas em atletas: correlação com a intensidade de desporto e o nível de competição" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2010 "Ancho" => 1318 "Tamanyo" => 627547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of abnormal (training-unrelated) ECG findings (A: Seattle criteria; B: Refined Criteria) according to intensity of sport – low-moderate vs. high (categories III and/or C). Max O<span class="elsevierStyleInf">2</span>: maximal oxygen uptake; MVC: maximal voluntary contraction. 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(A) Arterial oxygen saturation (SO<span class="elsevierStyleInf">2</span>) at baseline and at different intervals (p-value shows the difference between SO<span class="elsevierStyleInf">2</span> at that follow-up and baseline value on t test); (B) Z-scores of pulmonary artery (PA) branches at baseline and at different intervals showing parallel growth of the PA branches at follow-up (p-value shows the difference between Z-scores of the PA branch at that follow-up and baseline value on Wilcoxon paired signed-rank test).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Abhishek Raval, Bhavesh Thakkar, Tarun Madan, Nilesh Oswal, Rajiv Garg, Rhshikesh Umalkar, Komal Shah, Bhumika Maheriya" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Abhishek" "apellidos" => "Raval" ] 1 => array:2 [ "nombre" => "Bhavesh" "apellidos" => "Thakkar" ] 2 => array:2 [ "nombre" => "Tarun" "apellidos" => "Madan" ] 3 => array:2 [ "nombre" => "Nilesh" "apellidos" => "Oswal" ] 4 => array:2 [ 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class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "600" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hélder Dores, Aneil Malhotra, Nabeel Sheikh, Lynne Millar, Harshil Dhutia, Rajay Narain, Ahmed Merghani, Michael Papadakis, Sanjay Sharma" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Hélder" "apellidos" => "Dores" "email" => array:1 [ 0 => "heldores@hotmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Aneil" "apellidos" => "Malhotra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Nabeel" "apellidos" => "Sheikh" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Lynne" "apellidos" => "Millar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Harshil" "apellidos" => "Dhutia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Rajay" "apellidos" => "Narain" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Ahmed" "apellidos" => "Merghani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "Michael" "apellidos" => "Papadakis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 8 => array:3 [ "nombre" => "Sanjay" "apellidos" => "Sharma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital das Forças Armadas, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital da Luz, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "NOVA Medical School, Lisboa, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Cardiovascular Sciences, St. George's University of London, London, United Kingdom" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Alterações eletrocardiográficas em atletas: correlação com a intensidade de desporto e o nível de competição" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3330 "Ancho" => 1583 "Tamanyo" => 202404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of abnormal ECG changes (A: Seattle criteria; B: Refined Criteria) according to the combination of type/intensity of sport and competitive level. Int.: international; Nat.: national.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Repeated exercise training induces various cardiovascular adaptations that can manifest as changes in the resting 12-lead electrocardiogram (ECG). These changes can be classified as pathological in non-athletic individuals but considered physiological and training-related in athletes.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> However, evaluation of the athlete's ECG is challenging because various physiological adaptations can overlap with conditions associated with an increased risk of sudden cardiac death.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence, pattern and degree of ECG changes are not uniform among athletes and are dependent on various factors including age,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,3</span></a> gender<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4–6</span></a> and ethnicity.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7,8</span></a> Although a higher prevalence of marked ECG changes has been reported in athletes engaged in high-intensity endurance sports, the association between the type of sport and the occurrence of abnormal ECG findings in athletes is not well established. The majority of existing studies reporting ECG changes according to the type of sport were performed in small populations, mainly covering endurance disciplines, and did not include sports characterized by different loading conditions.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,9,10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The conventional dual division between endurance/dynamic and static/strength sports seems rather simplistic. Many sporting disciplines combine elements of both types of exercise, and it can therefore be difficult to establish which is predominant. Additionally, factors such as duration of training and emotional stress related to competition are not taken into consideration.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of the study was to assess the association between intensity of sport and level of competition with the presence of abnormal ECG findings in athletes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Athletes</span><p id="par0025" class="elsevierStylePara elsevierViewall">Between September 2006 and July 2012, 15<span class="elsevierStyleHsp" style=""></span>175 young individuals (aged between 14 and 35 years) underwent cardiac evaluation in the UK, as part of a pre-participation screening program established by the charitable organization Cardiac Risk in the Young. For the purpose of this study selected athletes were defined as individuals involved in regular competition (regional, national or international) and training more than four hours per week. The final population comprised 3423 athletes. Cardiac evaluation consisted of a self-report health questionnaire, physical examination and a 12-lead ECG. On an individual basis, when indicated for clinical reasons, ECG abnormalities or research, transthoracic echocardiography was also performed. All the athletes included in this analysis were asymptomatic and normotensive at rest (<140/90 mmHg). Ethnicity, number of hours of exercise-training/week and level of competition were self-assigned.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">12-lead electrocardiogram</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 12-lead ECG was performed using GE<span class="elsevierStyleSup">®</span> Marquette Hellige (Milwaukee, WI, USA) or Philips<span class="elsevierStyleSup">®</span> Pagewriter Trim III (Bothell, WA, USA) electrocardiographs, with a paper speed of 25 mm/s and amplification of 0.1 mV/mm, as previously described.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> Heart rate and QRS axis were calculated; intervals, durations, and voltages were measured in each lead. The ECGs were analyzed by the cardiologist responsible for each screening session and later read independently by two cardiologists, highly experienced in sports cardiology, cardiomyopathies and primary electrical cardiac diseases. All ECGs were interpreted and categorized as normal (without changes or with training-related changes) or abnormal (with changes that justified additional investigations for exclusion of cardiac pathology) in accordance with the Seattle criteria (SC) and the Refined Criteria (RC).<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13–16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Transthoracic echocardiogram</span><p id="par0035" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography was performed by a cardiologist or a senior cardiac physiologist, using a Philips<span class="elsevierStyleSup">®</span> Sonos 7500, Philips<span class="elsevierStyleSup">®</span> iE33, or Philips<span class="elsevierStyleSup">®</span> CPX50 (Bothell, WA, USA) and Acuson Computed Sono-graph<span class="elsevierStyleSup">®</span> 128XP/10c (San Jose, CA, USA). Standard views and chamber measurements were performed as previously suggested.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> Left ventricular wall thickness was measured in two-dimensional (2D) parasternal short axis, at the level of the mitral valve and papillary muscles, and right ventricular dimensions were measured in apical 4-chamber view and right ventricular outflow in parasternal short-axis view at the aortic valve level. Color tissue Doppler and 2D continuous and pulsed Doppler were performed using standard parasternal and apical views. Assessment of diastolic function included pulsed Doppler across the mitral valve and tissue Doppler velocity imaging of the septal and lateral mitral valve annulus and free wall tricuspid valve annulus. An experienced cardiac physiologist independently repeated all cardiac measurements.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Classification of sports</span><p id="par0040" class="elsevierStylePara elsevierViewall">The sporting disciplines of all the athletes included in the study were categorized according to the classification proposed by Mitchel et al. in the 36th Bethesda Conference guidelines.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> This classification is based on the peak of static and dynamic components achieved during exercise, evaluated by maximal oxygen uptake and maximal voluntary contraction.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The volume of training was analyzed according to the number of hours performed per week and the competitive level was stratified according to the nature of the competition – regional, national or international.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following categories were formulated, according to which the distribution of abnormal ECG changes was analyzed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Intensity of sport: low/moderate vs. at least one high static or dynamic component (categories III and/or C of the Mitchell et al. classification)<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Competitive level: regional vs. national/international</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Training volume: ≤20 vs. >20 hours/week</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Type of sport: high static vs. high dynamic component.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical approval and consent</span><p id="par0075" class="elsevierStylePara elsevierViewall">Written consent was obtained from individuals aged 16 years or over and from a parent for those aged less than 16 years. The National Research Ethics Service, Essex 2 Research Ethics Committee, granted ethical approval in the UK.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Continuous variables with normal distribution were expressed as means and standard deviations. Normality was tested with the Kolmogorov-Smirnov test. Categorical variables were expressed as frequencies and percentages. Statistical comparison of baseline characteristics was performed using the chi-square test or Fisher's exact test, when appropriate, and the Student's t test or the Mann-Whitney test for continuous variables. To identify independent predictors of abnormal SC, multivariate analysis using a binary logistic regression model (enter method) was performed. Two-tailed tests of significance are reported. For all comparisons, a p value of <0.05 was considered statistically significant. When appropriate, 95% confidence intervals (CI) were calculated. The statistical analysis was performed with SPSS version 21.0 (SPSS<span class="elsevierStyleSup">®</span> Inc., Chicago, IL, USA).</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Baseline characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 3423 athletes included in the final analysis, mean age was 20.1±5.0 years, 2468 (72.1%) were male and the majority were Caucasian (90.1%). Athletes were engaged in 43 sporting disciplines, with rugby (35.0%), football (9.7%), swimming (6.3%) and rowing/canoeing (4.6%) being the most popular sports. Almost half of the overall population (46.3%) were engaged in sports with a high static and/or high dynamic component (category III and/or C). Regarding the competitive level, 795 (23.2%) athletes were involved in regional, 1277 (37.3%) in national and 1352 (39.5%) in international competitions. The mean number of training hours/week was 16.2±7.7 (5-50 hours), with 714 (20.9%) of athletes training for >20 hours/week.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Electrocardiographic findings</span><p id="par0090" class="elsevierStylePara elsevierViewall">Based on the SC, approximately 80% of the overall population (n=2731) had alterations in the 12-lead ECG: normal/training-related in 2482 (72.5%) and abnormal/training-unrelated in 225 (6.6%) athletes. Among the abnormal ECG changes, the most prevalent were left atrial enlargement in 76 athletes (2.1%), left axis deviation in 47 (1.4%), T-wave inversions in 42 (1.2%) and Wolff-Parkinson White pattern in 28 (0.01) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These abnormal ECG findings were more frequent in athletes involved in high-intensity sports (8.0% vs. 5.4%; p=0.002) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Athletes with abnormal SC were more likely to be of Black/Caribbean descendent (8.0% vs. 5.0%; p=0.047) and to compete at national/international level (82.7% vs. 76.3%; p=0.028) in sports with a high static or dynamic component (56.0% vs. 45.6%; p=0.002). Athletes involved in disciplines with predominantly high dynamic intensity (classes C–I/II) had a higher rate of abnormal ECG changes (9.1% vs. 5.5%; p<0.001), but there was no significant difference in sports with high static intensity (III-A/B) (4.5% vs. 6.7%; p=0.153). Comparing only athletes involved in disciplines with isolated high dynamic intensity (classes C-I/II) with those in high static intensity (classes III-A/B), the former had a higher rate of abnormal ECG changes (9.1% vs. 4.5%; p=0.014). Exercising >20 hours/week was not significantly associated with the presence of abnormal ECG changes (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">By multivariate analysis, national/international level (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.04-2.14; p=0.027) and high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) were independent predictors of abnormal ECG changes, with a trend for Black/Caribbean ethnicity (OR 1.58, 95% CI 0.95-2.62; p=0.078) (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 3</a>). The combination of the two independent variables revealed a significantly higher frequency of abnormal ECG findings in athletes competing in high-intensity sports at national/international level (8.7% vs. 5.5%; p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A).</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Interpretation of ECGs with the RC led to a decrease of more than half in the number of abnormal/training-unrelated ECG changes, to 103 (3.0%) athletes, including among those involved in high-intensity sports (4.2% vs. 2.0%; p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). These athletes with abnormal RC were more likely to be female (47.6% vs. 27.3%; <0.001) and to be involved in disciplines with predominantly high dynamic intensity (classes C-I/II) (4.7% vs. 2.3%; p<0.001), but there was no significant difference in disciplines with predominantly high static intensity (III-A/B) (2.6% vs. 3.0%; p=0.700). Comparing only athletes involved in disciplines with isolated high dynamic intensity (classes C-I/II) with those in high static intensity (classes III-A/B), there was no significant difference in prevalence of abnormal ECG changes (4.7% vs. 2.6%; p=0.127). Competing at national/international level (82.5% vs. 76.6%; p=0.161) and training >20 hours/week (19.4% vs. 20.9%; p=0.715) were not significantly associated with abnormal RC. However, the combination of intensity of sport and competitive level revealed significant abnormal ECG changes in athletes involved in high-intensity sports at national/international level (4.7% vs. 2.1%; p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Transthoracic echocardiography</span><p id="par0105" class="elsevierStylePara elsevierViewall">Of the overall population, 1345 (39.3%) athletes underwent transthoracic echocardiography. Structural findings were interpreted as abnormal in 26 (0.8%) athletes. The echocardiographic findings classified as abnormal were aortic bicuspid valve (n=7), isolated right ventricular changes (e.g. hypertrabeculation) (n=5), mitral valve prolapse (n=4), anomalous coronary origin (n=2), dilated aortic root (n=2), left ventricular hypertrophy with interventricular septum ≥15 mm (n=1), large patent foramen ovale (n=1), tricuspid valve prolapse (n=1), pulmonary valve stenosis (n=1), atrial septal defect (n=1) and cor triatriatum (n=1). These structural alterations were more frequent in athletes with both abnormal SC (2.7% vs. 0.6%; p=0.010) and abnormal RC (3.9% vs. 0.7%; p<0.001). A higher frequency of echocardiographic changes classified as abnormal was also evident in athletes engaged in high-intensity sports and competing at national/international level (1.3% vs. 0.5%; p=0.012).</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In the large cohort of competitive athletes under analysis, the rate of abnormal ECG changes suggestive of cardiovascular abnormalities decreased with the use of more restrictive criteria. Independently of the criteria used (SC or RC), ECG abnormalities were more common among athletes involved in sports characterized by a high dynamic and/or static component, mainly elite athletes competing at national or international level. Otherwise, there was no significant association between the number of hours of training/week and abnormal ECG changes. Abnormal structural changes identified by transthoracic echocardiography were more common in athletes with concomitant abnormal changes on the ECG, as well as in those involved in high-intensity sports and at the national/international level.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The rate of abnormal ECGs was lower than has previously been reported (10-14%), which is related to the use of more restrictive criteria (the SC and particularly the RC).<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1,8,16,18–20</span></a> In a recent study,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> use of the SC compared to the European Society of Cardiology (ESC) recommendations<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> significantly reduced the rate of false-positive ECG screening results, while still identifying athletes with cardiac conditions. The RC<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> showed an additional improvement compared to the SC, with a significant decrease in false positives in both black and white athletes, without compromising the sensitivity of the ECG in detecting pathological conditions. In fact, some ECG findings, including isolated axis deviation and atrial enlargement, which account for a large number of changes in athletes’ ECGs, do not predict structural cardiac disease when assessed by transthoracic echocardiography.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Intensity and type of sport</span><p id="par0120" class="elsevierStylePara elsevierViewall">Few studies have reported the association of type of sport with ECG findings in athletes, and these were mainly performed before the publication of guidelines for ECG interpretation in athletes, in which the sporting disciplines were analyzed individually and not according to the intensity of the dynamic and static components of exercise.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">20,21</span></a> A higher prevalence of ECG changes in athletes has been mainly reported in endurance disciplines. Pelliccia et al.,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> in 1005 athletes performing at national or international level in 38 different sporting disciplines, showed that abnormal ECG changes were more common in endurance sports such as cycling, canoeing/rowing and cross-country skiing. Athletes engaged in endurance sports exhibit more pronounced physiological structural remodeling, which may also manifest with marked ECG alterations. The present study revealed that this relationship between intensity of sport and ECG changes is also evident for non-physiological changes. However, these results should be interpreted with caution. Despite the differences in cardiac loading conditions induced by different types of exercise, some ECG abnormalities are found in athletes engaged in predominantly dynamic as well as in those in predominantly static sports. Although the association is more evident in sports with high dynamic levels, sporting disciplines in this study are typically characterized by a combination of both types of exercise (at least one type with moderate intensity), as in rugby, swimming and basketball.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Competitive level</span><p id="par0125" class="elsevierStylePara elsevierViewall">The impact of competitive level on electrical remodeling is also not well established and has not been considered in previous classifications of sports. The majority of previous studies were performed in athletes with similar levels of competition, mostly at national or international level. Nonetheless, given the large number of individuals involved in regular sports training at low levels of competition (club or regional) or even not competing, it is important to analyze cardiovascular adaptations in a broad spectrum of competitive levels as well as the other factors that play a part.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Although this idea is controversial, it has been proposed that the emotional stress of competition can induce sympathetic activation, which is a potential trigger for arrhythmias or myocardial ischemia.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> It might be assumed that sports played at higher levels of competition (national or international), independently of the intensity of physical exercise, would be associated with greater psychological stress. Nevertheless, no relation between emotional stress induced by highly competitive sport and ECG abnormalities has been reported.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Training volume</span><p id="par0130" class="elsevierStylePara elsevierViewall">Although there is an empirical assumption that the cause-effect relationship between the volume of training and electrical remodeling is obvious, there is little evidence of abnormal ECG findings and the idea is controversial. In a study by Papadakis et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> in adolescent Caucasian athletes, the duration of training was not an independent predictor for T-wave inversion in the precordial leads, one of the most frequent abnormalities seen in the ECGs of competitive athletes. Comparing athletes training for fewer hours a week with those training more, the latter more frequently have ECG changes, as shown by Gati et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> with respect to left axis deviation and left atrial enlargement.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our results offer new insights regarding the association of intensity and level of competition with the presence of abnormal ECG findings, and highlight characteristics that should be considered together when interpreting an athlete's ECG.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Limitations</span><p id="par0140" class="elsevierStylePara elsevierViewall">The present study has some limitations that should be highlighted. The analysis was retrospective. Some of the characteristics, such as the volume of training, were self-reported by the athletes. Although this was a large cohort compared to previous studies, larger populations should be analyzed, bearing in mind the low rate of the endpoints studied. The low representation of some groups, such as females and non-Caucasians, limits the generalization of these results. Athletes at the extreme end of the spectrum (those with the highest sporting intensity and competitive level) may be more prone to develop abnormal ECG changes. For those with intermediate levels of intensity and competition, correlation with the presence of abnormal ECG findings is difficult to establish due to the dichotomized criteria used in this study. The categorization of sports into nine groups, as in the classification of Mitchell et al.,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> makes this less easy to implement and further subdividing sports may hinder reliable comparisons between the different categories. Although this was not the aim of the study, it is difficult to establish associations between echocardiographic abnormalities and ECG findings; transthoracic echocardiography was not systematically performed and the main purpose of the study was research.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">The present study shows a positive correlation between greater intensity of sport and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation (the ‘Refined Criteria’), although the number of abnormal ECGs is lower. The characteristics of specific sports should be taken into account when evaluating elite athletes, to help with early identification of those who may be more prone to develop ECG abnormalities and to prevent unnecessary subsequent evaluation and unwarranted disqualification from competitive sport.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Ethical disclosures</span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Protection of human and animal subjects</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Confidentiality of data</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Right to privacy and informed consent</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres748704" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec751450" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres748705" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec751451" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Athletes" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "12-lead electrocardiogram" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Transthoracic echocardiogram" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Classification of sports" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical approval and consent" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Electrocardiographic findings" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Transthoracic echocardiography" ] ] ] 7 => array:3 [ "identificador" => "sec0065" "titulo" => "Discussion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Intensity and type of sport" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Competitive level" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Training volume" ] ] ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0095" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0105" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0110" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0115" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-03" "fechaAceptado" => "2016-04-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec751450" "palabras" => array:4 [ 0 => "Electrocardiogram" 1 => "Athletes" 2 => "Type of sport" 3 => "Competitive level" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec751451" "palabras" => array:4 [ 0 => "Eletrocardiograma" 1 => "Atletas" 2 => "Tipo de desporto" 3 => "Nível competitivo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Athletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (≤20 vs. >20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the ‘Refined Criteria’ (RC).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; p<0.001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is a positive correlation between higher intensity of sports and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation, although the number of abnormal ECGs is lower.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O eletrocardiograma (ECG) do atleta pode apresentar alterações que requerem avaliações adicionais, aparentemente mais frequentes nos desportos de <span class="elsevierStyleItalic">endurance</span>. O objetivo deste trabalho foi avaliar a associação entre a presença de alterações no ECG do atleta com a intensidade de desporto e nível competitivo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Uma coorte de 3423 atletas de nível competitivo realizaram ECG que foi interpretado pelos critérios de Seattle (CS). A presença de alterações anormais foi correlacionada com: 1) intensidade de desporto (baixo/moderado <span class="elsevierStyleItalic">versus</span> pelo menos um componente elevado, estático ou dinâmico); 2) nível competitivo (regional <span class="elsevierStyleItalic">versus</span> nacional/internacional); 3) volume de treino (≤20 <span class="elsevierStyleItalic">versus</span> >20 horas/semana); 4) tipo de desporto (elevados componentes dinâmico <span class="elsevierStyleItalic">versus</span> estático). Os mesmos <span class="elsevierStyleItalic">endpoints</span> foram estudados pelos <span class="elsevierStyleItalic">Refined Criteria</span> (RC).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De acordo com os SC, 225 (6,6%) atletas tinham alterações patológicas, mais frequentes nos envolvidos em desportos de elevada intensidade (8,0 <span class="elsevierStyleItalic">versus</span> 5,4%; p=0,002), sobretudo dinâmica, e em nível nacional/internacional (7,1 <span class="elsevierStyleItalic">versus</span> 4,9%; p=0,028). O volume de treino não esteve significativamente associado a estas alterações. Em análise multivariada, desporto de elevada intensidade (OR 1,55, IC 95% 1,18-2,03; p=0,002) e o nível nacional/internacional (OR 1,50, IC 95% 1,04-2,14; p=0,027) foram preditores independentes de ECG anormais, variáveis que combinadas duplicaram a prevalência. Com os RC o número de ECG patológicos decresceu para 103 (3,0%), também mais frequentes nos desportos de elevada intensidade (4,2 <span class="elsevierStyleItalic">versus</span> 2,0%; p<0,001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusões</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Verificou-se uma correlação positiva entre desporto de elevada intensidade e nível competitivo com alterações ECG consideradas patológicas. Apesar do menor número destas alterações, esta relação persiste com o uso de critérios mais restritivos na sua interpretação.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3363 "Ancho" => 2199 "Tamanyo" => 859852 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of abnormal (training-unrelated) ECG findings (A: Seattle criteria; B: Refined Criteria) according to intensity of sport – low-moderate vs. high (categories III and/or C). Max O<span class="elsevierStyleInf">2</span>: maximal oxygen uptake; MVC: maximal voluntary contraction. Adapted from Mitchell et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3330 "Ancho" => 1583 "Tamanyo" => 202404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of abnormal ECG changes (A: Seattle criteria; B: Refined Criteria) according to the combination of type/intensity of sport and competitive level. Int.: international; Nat.: national.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left atrial enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left axis deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T-wave inversion (excluding aVR, III and V1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wolff-Parkinson-White pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right axis deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Long QT interval \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST-segment depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complete left bundle branch block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraventricular conduction delay (QRS >140 ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pathological Q waves \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brugada type 2 pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (<0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1236219.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abnormal electrocardiographic changes.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">D: deviation; SC: Seattle criteria.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With abnormal SC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without abnormal SC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Demographic</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age (mean ± D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1±5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.8±5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1±5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.316 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2468 (72.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 (69.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2312 (72.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.338 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3085 (90.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">197 (87.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2888 (90.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.181 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Black/Caribbean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">177 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.047 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.467 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other ethnicity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.507 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Competitive level and training volume</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>National/international \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2625 (76.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186 (82.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2439 (76.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No. hours/week (mean ± D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.2±7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.0±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.7±7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.734 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>20 hours/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">714 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (21.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">666 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.856 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Intensity of sports (Mitchell classification)</span><a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">540 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">504 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.924 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1566 (45.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1491 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1317 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114 (50.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1203 (37.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">933 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (29.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">866 (27.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.380 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1938 (56.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1813 (56.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.840 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">552 (16.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">520 (16.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.422 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High intensity (at least one of III/C) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1584 (46.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1458 (45.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Greater dynamic intensity (C-I/II) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1033 (30.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (41.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">939 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Greater static intensity (III-A/B) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">267 (7.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">255 (8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.153 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1236218.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">p value for comparisons: athletes with abnormal SC vs. athletes without abnormal SC.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prevalence of baseline characteristics according to the presence or absence of abnormal Seattle criteria.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13–15</span></a></p>" ] ] 4 => array:8 [ "identificador" => "tbl0035" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; OR: odds ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Black/Caribbean ethnicity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95-2.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.078 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">National/international level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04-2.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High-intensity sports \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.18-2.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1236217.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Independent predictors of abnormal changes according to the Seattle criteria by multivariate analysis (binary logistic regression).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. 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Ano/Mês | Html | Total | |
---|---|---|---|
2024 Novembro | 5 | 5 | 10 |
2024 Outubro | 45 | 37 | 82 |
2024 Setembro | 56 | 35 | 91 |
2024 Agosto | 49 | 24 | 73 |
2024 Julho | 70 | 34 | 104 |
2024 Junho | 50 | 22 | 72 |
2024 Maio | 45 | 23 | 68 |
2024 Abril | 48 | 36 | 84 |
2024 Maro | 68 | 23 | 91 |
2024 Fevereiro | 61 | 36 | 97 |
2024 Janeiro | 37 | 36 | 73 |
2023 Dezembro | 27 | 28 | 55 |
2023 Novembro | 37 | 20 | 57 |
2023 Outubro | 43 | 14 | 57 |
2023 Setembro | 41 | 21 | 62 |
2023 Agosto | 41 | 20 | 61 |
2023 Julho | 50 | 11 | 61 |
2023 Junho | 34 | 21 | 55 |
2023 Maio | 52 | 28 | 80 |
2023 Abril | 22 | 1 | 23 |
2023 Maro | 70 | 31 | 101 |
2023 Fevereiro | 36 | 17 | 53 |
2023 Janeiro | 38 | 64 | 102 |
2022 Dezembro | 50 | 27 | 77 |
2022 Novembro | 52 | 24 | 76 |
2022 Outubro | 50 | 16 | 66 |
2022 Setembro | 29 | 28 | 57 |
2022 Agosto | 32 | 19 | 51 |
2022 Julho | 43 | 36 | 79 |
2022 Junho | 40 | 16 | 56 |
2022 Maio | 27 | 36 | 63 |
2022 Abril | 41 | 32 | 73 |
2022 Maro | 44 | 36 | 80 |
2022 Fevereiro | 44 | 19 | 63 |
2022 Janeiro | 43 | 29 | 72 |
2021 Dezembro | 25 | 26 | 51 |
2021 Novembro | 52 | 40 | 92 |
2021 Outubro | 59 | 30 | 89 |
2021 Setembro | 49 | 30 | 79 |
2021 Agosto | 54 | 41 | 95 |
2021 Julho | 39 | 26 | 65 |
2021 Junho | 45 | 22 | 67 |
2021 Maio | 62 | 40 | 102 |
2021 Abril | 93 | 60 | 153 |
2021 Maro | 98 | 37 | 135 |
2021 Fevereiro | 70 | 16 | 86 |
2021 Janeiro | 63 | 41 | 104 |
2020 Dezembro | 64 | 13 | 77 |
2020 Novembro | 51 | 29 | 80 |
2020 Outubro | 74 | 26 | 100 |
2020 Setembro | 132 | 26 | 158 |
2020 Agosto | 42 | 13 | 55 |
2020 Julho | 71 | 14 | 85 |
2020 Junho | 60 | 16 | 76 |
2020 Maio | 63 | 12 | 75 |
2020 Abril | 95 | 16 | 111 |
2020 Maro | 73 | 15 | 88 |
2020 Fevereiro | 159 | 23 | 182 |
2020 Janeiro | 59 | 11 | 70 |
2019 Dezembro | 59 | 15 | 74 |
2019 Novembro | 42 | 9 | 51 |
2019 Outubro | 46 | 22 | 68 |
2019 Setembro | 114 | 11 | 125 |
2019 Agosto | 49 | 19 | 68 |
2019 Julho | 72 | 15 | 87 |
2019 Junho | 45 | 20 | 65 |
2019 Maio | 73 | 6 | 79 |
2019 Abril | 55 | 19 | 74 |
2019 Maro | 57 | 8 | 65 |
2019 Fevereiro | 85 | 19 | 104 |
2019 Janeiro | 108 | 10 | 118 |
2018 Dezembro | 146 | 14 | 160 |
2018 Novembro | 170 | 8 | 178 |
2018 Outubro | 417 | 27 | 444 |
2018 Setembro | 118 | 9 | 127 |
2018 Agosto | 55 | 31 | 86 |
2018 Julho | 36 | 9 | 45 |
2018 Junho | 46 | 14 | 60 |
2018 Maio | 69 | 30 | 99 |
2018 Abril | 132 | 32 | 164 |
2018 Maro | 159 | 17 | 176 |
2018 Fevereiro | 98 | 10 | 108 |
2018 Janeiro | 170 | 18 | 188 |
2017 Dezembro | 261 | 14 | 275 |
2017 Novembro | 94 | 20 | 114 |
2017 Outubro | 46 | 12 | 58 |
2017 Setembro | 40 | 13 | 53 |
2017 Agosto | 40 | 18 | 58 |
2017 Julho | 34 | 23 | 57 |
2017 Junho | 37 | 23 | 60 |
2017 Maio | 38 | 30 | 68 |
2017 Abril | 21 | 24 | 45 |
2017 Maro | 26 | 23 | 49 |
2017 Fevereiro | 22 | 22 | 44 |
2017 Janeiro | 32 | 22 | 54 |
2016 Dezembro | 60 | 40 | 100 |
2016 Novembro | 76 | 87 | 163 |
2016 Outubro | 46 | 61 | 107 |
2016 Setembro | 1 | 4 | 5 |