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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introdu&#231;&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O exerc&#237;cio f&#237;sico intenso e prolongado condiciona adapta&#231;&#245;es card&#237;acas fisiol&#243;gicas conhecidas por &#171;cora&#231;&#227;o de atleta&#187;&#46; Entre estas altera&#231;&#245;es destacam&#8208;se o aumento das dimens&#245;es&#44; volumes e massa card&#237;acas e a melhoria de par&#226;metros funcionais&#44; nomeadamente da fun&#231;&#227;o diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; Tradicionalmente&#44; existem dois tipos de remodelagem card&#237;aca&#58; remodelagem conc&#234;ntrica associada a exerc&#237;cio est&#225;tico e exc&#234;ntrica associada a exerc&#237;cio din&#226;mico<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a>&#46; Por exemplo&#44; os maratonistas apresentam remodelagem exc&#234;ntrica pela sobrecarga de volume resultante do aumento do d&#233;bito card&#237;aco&#44; enquanto os halterofilistas apresentam remodelagem conc&#234;ntrica pela sobrecarga de press&#227;o<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a>&#46; De real&#231;ar que esta subdivis&#227;o n&#227;o dever&#225; ser estanque&#44; porque a maioria das modalidades desportivas t&#234;m influ&#234;ncias de ambos os tipos de exerc&#237;cio &#8211; isom&#233;trico e isot&#243;nico&#44; o que condicionar&#225; uma remodelagem com caracter&#237;sticas mistas<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No entanto&#44; os atletas n&#227;o s&#227;o os &#250;nicos indiv&#237;duos a estarem sujeitos a treinos de elevada intensidade&#46; Os militares constituem outro exemplo&#44; particularmente as for&#231;as especiais&#44; com uma exigente forma&#231;&#227;o a n&#237;vel f&#237;sico&#44; caracterizada por m&#250;ltiplas modalidades dos dois tipos de exerc&#237;cio&#46; Estes militares podem ser globalmente equiparados a atletas de n&#237;vel competitivo&#44; muitas vezes at&#233; com volumes de exerc&#237;cio superiores&#46; Contudo&#44; o treino militar apresenta algumas particularidades&#44; desde as metodologias utilizadas &#224; influ&#234;ncia de m&#250;ltiplas vari&#225;veis inerentes &#224; condi&#231;&#227;o militar<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico pode manifestar&#8208;se com caracter&#237;sticas sobrepostas a achados presentes em situa&#231;&#245;es patol&#243;gicas&#44; nomeadamente miocardiopatias&#44; sendo muitas vezes desafiante o seu diagn&#243;stico diferencial<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#46; Neste &#226;mbito&#44; a avalia&#231;&#227;o pr&#233;&#8208;competitiva de atletas e a interpreta&#231;&#227;o dos exames complementares de diagn&#243;stico realizados nesta popula&#231;&#227;o reveste&#8208;se de enorme import&#226;ncia&#46; Na &#250;ltima d&#233;cada foram desenvolvidas novas metodologias imagiol&#243;gicas que permitem uma avalia&#231;&#227;o mioc&#225;rdica pormenorizada&#44; como a an&#225;lise da mec&#226;nica mioc&#225;rdica por ecocardiografia transtor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Os objetivos principais deste trabalho foram caracterizar e comparar a remodelagem card&#237;aca em atletas profissionais de basquetebol ao longo de uma &#233;poca desportiva e em militares num curso de for&#231;as especiais&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Metodologia</span><p id="par0130" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; longitudinal de caso&#8208;controlo&#44; em que foram avaliados militares de for&#231;as especiais e atletas de alta competi&#231;&#227;o no in&#237;cio e no fim do curso militar e de uma &#233;poca desportiva&#44; respetivamente&#46; Foram inclu&#237;dos indiv&#237;duos &#40;militares ou atletas&#41; do g&#233;nero masculino ou feminino&#44; com idades entre os 18&#8208;35 anos&#46; Os militares foram selecionados entre aqueles que ingressaram num curso de Comandos do Ex&#233;rcito Portugu&#234;s&#44; sendo avaliados entre janeiro e junho de 2016&#46; Os atletas pertenciam a duas equipas de basquetebol profissional&#44; uma masculina e outra feminina&#44; competindo na 1&#46;&#170; divis&#227;o masculina&#47;liga feminina a n&#237;vel nacional&#44; tendo sido avaliados em outubro de 2015 e mar&#231;o&#47;abril de 2016&#46; Portanto&#44; ambos os grupos foram avaliados com cerca de seis meses de intervalo&#46; A popula&#231;&#227;o de militares&#44; inicialmente composta por 76 formandos&#44; englobou 17 militares&#44; correspondendo aos que conclu&#237;ram o curso com sucesso e preencheram os crit&#233;rios de inclus&#227;o &#40;taxa de desist&#234;ncia aproximada de 70&#37;&#44; 54 instruendos&#41;&#46; Todos estes militares tinham hist&#243;ria pr&#233;via de pr&#225;tica de desporto em n&#237;vel competitivo&#46; A popula&#231;&#227;o de atletas correspondeu a 17 basquetebolistas&#44; oito do g&#233;nero masculino e nove do feminino&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Todos os ind&#237;viduos foram volunt&#225;rios e deram o seu consentimento informado para participarem no estudo&#46; O protocolo foi aprovado pela Comiss&#227;o de &#201;tica da Faculdade de Medicina da Universidade de Coimbra &#40;protocolo de refer&#234;ncia &#8211; 087&#47;2015&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Caracter&#237;sticas do exerc&#237;cio f&#237;sico da popula&#231;&#227;o estudada</span><p id="par0140" class="elsevierStylePara elsevierViewall">O curso de Comandos caracteriza&#8208;se por exerc&#237;cio f&#237;sico de elevada intensidade&#44; com os objetivos de desenvolver a capacidade aer&#243;bica e anaer&#243;bica&#46; Para este fim&#44; os militares s&#227;o sujeitos a treino f&#237;sico din&#226;mico e est&#225;tico&#44; englobando v&#225;rias modalidades desportivas como atletismo&#44; nata&#231;&#227;o&#44; gin&#225;stica&#44; levantamento de pesos&#44; entre outros&#46; Para al&#233;m destes exerc&#237;cios&#44; s&#227;o sujeitos a treino f&#237;sico de aplica&#231;&#227;o militar cujo objetivo &#233; adquirir e desenvolver t&#233;cnicas e capacidades psicomotoras que permitam ao militar desempenhar as suas fun&#231;&#245;es em condi&#231;&#245;es adversas&#46; Este treino f&#237;sico de aplica&#231;&#227;o militar consiste na realiza&#231;&#227;o de pistas de obst&#225;culos&#44; corridas intensas intercaladas com marcha&#44; transporte de cargas&#44; entre outras atividades&#46; O programa de treino do curso foi realizado em duas fases&#58; primeira fase &#8211; dez semanas com exerc&#237;cio f&#237;sico de intensidade vigorosa &#40;77&#8208;95&#37; da frequ&#234;ncia card&#237;aca &#91;FC&#93; m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#44; frequ&#234;ncia de cinco vezes&#47;semana e dura&#231;&#227;o m&#233;dia de quatro horas&#47;dia&#59; segunda fase &#8211; 15 semanas com exerc&#237;cio f&#237;sico de intensidade vigorosa &#40;77&#8208;95&#37; da FC m&#225;xima&#41; intercalado com per&#237;odos de exerc&#237;cio de intensidade quase m&#225;ximo ou m&#225;ximo &#40;&#62;<span class="elsevierStyleHsp" style=""></span>96&#37; da FC m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#44; frequ&#234;ncia de cinco vezes&#47;semana e dura&#231;&#227;o m&#233;dia de quatro horas&#47;dia&#46; Para al&#233;m deste treino programado&#44; estes militares est&#227;o sob permanente desgaste f&#237;sico&#44; psicol&#243;gico e emocional&#44; de dif&#237;cil quantifica&#231;&#227;o&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O basquetebol engloba uma multiplicidade de movimentos&#44; realizados com base na velocidade&#44; habilidade e for&#231;a&#44; requerendo exerc&#237;cios din&#226;micos e est&#225;ticos&#44; com uma componente geral e outra espec&#237;fica&#46; A componente geral &#233; trabalhada com corrida cont&#237;nua&#44; velocidade e mudan&#231;as de dire&#231;&#227;o&#44; exerc&#237;cios de gin&#225;stica e flexibilidade&#46; A componente espec&#237;fica engloba&#44; sobretudo&#44; treino de coordena&#231;&#227;o com aprendizagem e aperfei&#231;oamento de gestos t&#233;cnicos&#46; Os atletas treinam quatro vezes&#47;semana e t&#234;m um jogo por semana&#44; sendo a dura&#231;&#227;o m&#233;dia de cada treino cerca de tr&#234;s horas&#44; com tr&#234;s per&#237;odos distintos&#58; aquecimento&#44; treino de basquetebol com exerc&#237;cios gerais e espec&#237;ficos&#44; e retorno &#224; calma&#46; O basquetebol tem per&#237;odos em que os atletas s&#227;o sujeitos a intensidade de vigorosa a quase m&#225;xima&#44; com outros de intensidade baixa a moderada&#46; Globalmente&#44; os treinos destes atletas enquadravam&#8208;se no n&#237;vel de intensidade vigorosa &#40;77&#8208;95&#37; da FC m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Avalia&#231;&#227;o cl&#237;nica</span><p id="par0150" class="elsevierStylePara elsevierViewall">Todos os participantes foram submetidos a um exame f&#237;sico completo e hist&#243;ria cl&#237;nica rigorosa&#44; realizada por um m&#233;dico de medicina desportiva ou de cardiologia&#46; Enfatizou&#8208;se a pesquisa de fatores de risco cardiovasculares &#40;FRCV&#41;&#44; os h&#225;bitos alimentares e farmacol&#243;gicos&#44; e a hist&#243;ria desportiva&#44; incluindo o n&#250;mero de horas de treino e de sono durante o curso&#47; &#233;poca desportiva&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Avalia&#231;&#227;o antropom&#233;trica</span><p id="par0155" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o antropom&#233;trica foi realizada por um enfermeiro e um t&#233;cnico superior de sa&#250;de&#46; A altura foi avaliada atrav&#233;s de uma fita m&#233;trica&#44; enquanto o peso&#44; percentagem de massa gorda &#40;MG&#41; e massa muscular &#40;MM&#41; usando uma balan&#231;a digital de corpo inteiro com bioimped&#226;ncia &#40;HBF510W &#8208; OMRON<span class="elsevierStyleSup">&#174;</span>&#41;&#46; A medi&#231;&#227;o da press&#227;o arterial sist&#243;lica &#40;PAS&#41; e diast&#243;lica &#40;PAD&#41;&#44; e a FC foram avaliadas por um medidor de press&#227;o arterial &#40;PA&#41; de bra&#231;o &#40;HEM 7113 &#8208; OMRON<span class="elsevierStyleSup">&#174;</span>&#41;&#44; de acordo com as recomenda&#231;&#245;es atuais<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#46; Foram calculadas vari&#225;veis&#58; varia&#231;&#227;o &#40;&#916;&#41; peso&#44; &#916; MM&#44; &#916; MG&#59; &#916; PAS&#44; &#916; PAD pela seguinte f&#243;rmula&#58; &#40;par&#226;metro final &#8208; par&#226;metro inicial&#41; &#47; par&#226;metro inicial<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>100&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Avalia&#231;&#227;o eletrocardiogr&#225;fica</span><p id="par0160" class="elsevierStylePara elsevierViewall">Todos os indiv&#237;duos inclu&#237;dos realizaram eletrocardiograma &#40;ECG&#41; de 12 deriva&#231;&#245;es &#40;NORAV<span class="elsevierStyleSup">&#174;</span> modelo 1200HR&#41;&#44; analisados por dois cardiologistas e interpretados de acordo com os crit&#233;rios refinados<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Avalia&#231;&#227;o ecocardiogr&#225;fia</span><p id="par0165" class="elsevierStylePara elsevierViewall">Todos os ecocardiogramas transtor&#225;cios &#40;ETT&#41; foram realizados por um cardiologista com o ecocardi&#243;grafo Vivid 7&#44; GE Healthcare<span class="elsevierStyleSup">&#174;</span>&#44; englobando as diversas janelas ecocardiogr&#225;ficas e modalidades recomendadas pela Sociedade Europeia de Cardiologia &#40;bidimensional&#44; modo M&#44; <span class="elsevierStyleItalic">Doppler</span> cor&#44; pulsado&#44; cont&#237;nuo e tissular&#44; deforma&#231;&#227;o mioc&#225;rdica por <span class="elsevierStyleItalic">Speckle&#8208;Tracking&#41;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As medi&#231;&#245;es da espessura parietal e as dimens&#245;es do ventr&#237;culo esquerdo &#40;VE&#41; foram adquiridas em janela paraesternal eixo longo&#44; a espessura relativa das paredes &#40;ERP&#41; calculada pela f&#243;rmula &#40;2<span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span>parede posterior do VE &#91;PPVE&#93;&#47;di&#226;metro diast&#243;lico do VE &#91;DDVE&#93;&#41; e a massa VE pela f&#243;rmula de <span class="elsevierStyleItalic">Devereux&#39;s</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#46; O volume VE e da aur&#237;cula esquerda &#40;AE&#41; foi determinado pela regra de <span class="elsevierStyleItalic">Simpson</span> modificada&#44; com imagens obtidas em janela apical quatro e duas c&#226;maras&#46; O volume indexado da AE foi obtido por indexa&#231;&#227;o &#224; &#225;rea de superf&#237;cie corporal &#40;ASC&#41;&#46; A fra&#231;&#227;o de eje&#231;&#227;o VE &#40;FEVE&#41; foi determinada pelo m&#233;todo de <span class="elsevierStyleItalic">Simpson&#46;</span> O <span class="elsevierStyleItalic">Doppler</span> pulsado foi adquirido em janela apical quatro c&#226;maras&#44; sendo determinadas as velocidades de pico da onda <span class="elsevierStyleItalic">E</span>&#44; onda <span class="elsevierStyleItalic">A</span> e rela&#231;&#227;o <span class="elsevierStyleItalic">E&#47;A</span>&#46; As imagens do <span class="elsevierStyleItalic">Doppler</span> tecidular do anel mitral e tric&#250;spide foram obtidas para determinar as ondas <span class="elsevierStyleItalic">E</span> e <span class="elsevierStyleItalic">E&#8217;</span>&#44; e determinar as velocidades da onda <span class="elsevierStyleItalic">S&#8217;</span>&#44; respetivamente&#46; Por modo M determinou&#8208;se o plano de excurs&#227;o sist&#243;lica do anel tric&#250;spide &#40;TAPSE&#41;&#46; O <span class="elsevierStyleItalic">Speckle Tracking</span> utilizou&#8208;se para calcular a deforma&#231;&#227;o &#40;<span class="elsevierStyleItalic">strain</span>&#41; longitudinal global &#40;DLG&#41; do VE&#44; atrav&#233;s de imagens adquiridas em incid&#234;ncias apicais de quatro&#44; duas e tr&#234;s c&#226;maras&#44; representando um modelo mioc&#225;rdico de 18 segmentos&#46; A aquisic&#227;o dos ciclos card&#237;acos foi realizada durante a mesma fase respirat&#243;ria &#40;expira&#231;&#227;o&#41;&#44; sendo gravados tr&#234;s ciclos consecutivos e calculada a m&#233;dia para o ritmo sinusal&#44; com <span class="elsevierStyleItalic">frame rate</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60 <span class="elsevierStyleItalic">frames</span> por segundo&#46; A qualidade do exame foi considerada boa quando at&#233; no m&#225;ximo dois segmentos eram exclu&#237;dos&#44; e excelente quando todos os segmentos eram analisados&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a> exemplifica um ETT de um militar e de um atleta ap&#243;s o curso&#47;&#233;poca desportiva&#44; respetivamente&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lise estat&#237;stica</span><p id="par0180" class="elsevierStylePara elsevierViewall">As vari&#225;veis categ&#243;ricas foram apresentadas como frequ&#234;ncia e percentagem&#44; e os testes<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>e <span class="elsevierStyleItalic">Fisher</span> foram utilizados quando apropriados&#46; O teste <span class="elsevierStyleItalic">Kolmogorov&#8208;Smirnov</span> foi utilizado para verificar a distribui&#231;&#227;o das vari&#225;veis cont&#237;nuas&#46; As vari&#225;veis com distribui&#231;&#227;o normal foram expressas como m&#233;dia e desvio&#8208;padr&#227;o&#44; e o teste <span class="elsevierStyleItalic">T Student</span> foi utilizado para a compara&#231;&#227;o de grupos&#46; A homogeneidade das vari&#225;veis individuais foi avaliada pelo teste de <span class="elsevierStyleItalic">Levene</span>&#46; As vari&#225;veis com uma distribui&#231;&#227;o n&#227;o normal foram expressas como mediana e intervalos interquartil&#44; sendo os grupos comparados com os testes <span class="elsevierStyleItalic">Mann&#8208;Whitney</span> e <span class="elsevierStyleItalic">Kruskal&#8208;Wallis</span>&#46; A correla&#231;&#227;o de <span class="elsevierStyleItalic">Pearson</span> foi utilizada para analisar as associa&#231;&#245;es entre a MM e MG com os par&#226;metros ecocardiogr&#225;ficos&#46; Para todas as compara&#231;&#245;es o valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significativo&#44; com intervalo de confian&#231;a &#40;IC&#41; de 95&#37;&#46; Todos os dados foram calculados e analisados atrav&#233;s do programa SPSS&#44; vers&#227;o 20 &#40;SPSS<span class="elsevierStyleSup">&#174;</span> Inc&#46;&#44; Chicago&#44; IL&#44; EUA&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resultados</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Caracteriza&#231;&#227;o da popula&#231;&#227;o</span><p id="par0185" class="elsevierStylePara elsevierViewall">As carater&#237;sticas da popula&#231;&#227;o estudada est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46; Sucintamente&#44; destaca&#8208;se que os dois grupos tinham idades m&#233;dias id&#234;nticas&#44; havendo diferen&#231;a significativa quanto ao g&#233;nero e ra&#231;a caucasiana&#46; Os militares praticavam desporto de n&#237;vel competitivo h&#225; menos tempo e apresentavam um &#237;ndice de massa corporal &#40;IMC&#41; superior&#46; Durante o estudo os militares realizaram um n&#250;mero superior de horas de exerc&#237;cio programado por dia&#44; tiveram menos horas de descanso noturno e um menor n&#250;mero de refei&#231;&#245;es di&#225;rias&#46; Em rela&#231;&#227;o aos FRCV&#44; verificou&#8208;se que um quarto da popula&#231;&#227;o &#40;20&#44;6&#37;&#41; apresentava pelo menos um FRCV&#46; O tabagismo foi mais frequente e exclusivo nos militares &#40;17&#44;6&#37;&#41;&#44; seguido da dislipidemia&#44; tamb&#233;m mais frequente nesta popula&#231;&#227;o &#40;5&#44;9 <span class="elsevierStyleItalic">versus</span> 2&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;32&#41;&#46; A popula&#231;&#227;o n&#227;o apresentava hist&#243;ria familiar de doen&#231;a cardiovascular&#44; hipertens&#227;o arterial ou diabetes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Varia&#231;&#227;o dos dados antropom&#233;tricos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os militares tiveram um aumento significativo do peso corporal&#44; com aumento da MM e diminui&#231;&#227;o da MG&#44; PAS&#44; PAD e FC&#44; mais pronunciada que os basquetebolistas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; Analisando especificamente os indiv&#237;duos do g&#233;nero masculino&#44; estas altera&#231;&#245;es mantiveram&#8208;se para o aumento da percentagem de MM e diminui&#231;&#227;o da MG&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">A diferen&#231;a percentual na &#916; dos dados antropom&#233;tricos entre os dois grupos foi estatisticamente significativa para o peso&#44; PAS&#44; PAD&#44; MM e MG &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46; Verificou&#8208;se ganho de peso nos militares relativamente aos basquetebolistas &#40;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; com aumento da MM &#40;7&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1 <span class="elsevierStyleItalic">versus</span> 1&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e dimui&#231;&#227;o mais acentuada da MG &#40;&#8208;31&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;7 <span class="elsevierStyleItalic">versus</span> &#8208;0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Relativamente ao perfil tensional&#44; os militares tiveram redu&#231;&#227;o da PAS &#40;&#8208;4&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;0 <span class="elsevierStyleItalic">versus</span> 1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e da PAD &#40;&#8208;8&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 <span class="elsevierStyleItalic">versus</span> 1&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Avalia&#231;&#227;o eletrocardiogr&#225;fica</span><p id="par0200" class="elsevierStylePara elsevierViewall">Todos os ECG estavam em ritmo sinusal e foram considerados normais ou apenas com altera&#231;&#245;es fisiol&#243;gicas&#46; A altera&#231;&#227;o fisiol&#243;gica mais frequente foi a bradicardia sinusal &#40;41&#44;2&#37;&#41;&#44; seguida da repolariza&#231;&#227;o precoce &#40;29&#44;4&#37;&#41;&#44; hipertrofia do VE &#40;20&#44;6&#37;&#41;&#44; bloqueio incompleto do ramo direito &#40;11&#44;8&#37;&#41; e bloqueio aur&#237;culo ventricular de 1&#46;&#176; grau &#40;2&#44;9&#37;&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Avalia&#231;&#227;o ecocardiogr&#225;fica</span><p id="par0205" class="elsevierStylePara elsevierViewall">O ETT revelou diferentes padr&#245;es de remodelagem card&#237;aca estrutural &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; Nos militares verificou&#8208;se aumento das dimens&#245;es das cavidades esquerdas&#44; tanto do VE &#40;49&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2 <span class="elsevierStyleItalic">versus</span> 52&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; como da AE &#40;63&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5 <span class="elsevierStyleItalic">versus</span> 71&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1<span class="elsevierStyleHsp" style=""></span>mL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e diminui&#231;&#227;o da ERP &#40;0&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Nos atletas verificou&#8208;se diminui&#231;&#227;o das dimens&#245;es do VE &#40;52&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 <span class="elsevierStyleItalic">versus</span> 50&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; aumento do septo interventricular &#40;SIV&#41; &#40;8&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 <span class="elsevierStyleItalic">versus</span> 9&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e aumento da ERP &#40;0&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Relativamente aos par&#226;metros funcionais&#44; nos militares verificou&#8208;se uma redu&#231;&#227;o da FEVE em repouso &#40;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 <span class="elsevierStyleItalic">versus</span> 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e aumento da onda S&#8217;&#44; tanto nos militares &#40;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 <span class="elsevierStyleItalic">versus</span> 17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; como nos basquetebolistas &#40;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 <span class="elsevierStyleItalic">versus</span> 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">Quando avaliados separadamente os indiv&#237;duos do g&#233;nero masculino&#44; mantiveram&#8208;se os diferentes tipos de remodelagem descritos previamente&#44; existindo diferen&#231;a significativa no volume AE &#40;51&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1 <span class="elsevierStyleItalic">versus</span> 58&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;9<span class="elsevierStyleHsp" style=""></span>mL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e DLG &#40;&#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;17&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; nos basquetebolistas&#46; Apesar de a DLG n&#227;o apresentar diferen&#231;as significativas nos dois grupos no in&#237;cio e no fim do curso&#47;&#233;poca desportiva&#44; verificou&#8208;se uma diferen&#231;a significativa quando se estudaram os dois grupos em conjunto &#40;&#8208;20&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&#37; <span class="elsevierStyleItalic">versus</span> &#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; As diferen&#231;as percentuais relativas aos achados ecocardiogr&#225;ficos obtidos nos dois grupos mostraram diferen&#231;as na dimens&#227;o diast&#243;lica do VE&#44; ERP&#44; FEVE e onda S&#8217; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#46; As altera&#231;&#245;es relacionadas com a ERP e a dimens&#227;o diast&#243;lica do VE foram contr&#225;rias&#44; com os militares a diminu&#237;rem o valor da ERP em percentagem &#40;&#8208;10&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;3 <span class="elsevierStyleItalic">versus</span> 12&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e a aumentarem o DDVE &#40;6&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; enquanto nos basquetebolistas a ERP aumentou e o DDVE diminuiu durante a &#233;poca desportiva&#46; Estes dados s&#227;o semelhantes quando se comparam apenas militares e basquetebolistas do g&#233;nero masculino&#44; com diferen&#231;as percentuais significativas na ERP &#40;&#8208;10&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;3 <span class="elsevierStyleItalic">versus</span> 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; DDVE &#40;6&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e FEVE &#40;&#8208;5&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;8 <span class="elsevierStyleItalic">versus</span> 4&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discuss&#227;o</span><p id="par0215" class="elsevierStylePara elsevierViewall">Este estudo demonstrou a exist&#234;ncia de remodelagem antropom&#233;trica e cardiovascular nos militares e nos basquetebolistas&#46; Estas adapta&#231;&#245;es tiveram carater&#237;sticas distintas nos dois grupos&#46; Relativamente aos dados antropom&#233;tricos&#44; os militares tiveram um aumento mais marcado do peso corporal&#44; com ganhos de MM e diminui&#231;&#227;o de MG&#46; A avalia&#231;&#227;o ecocardiogr&#225;fica revelou padr&#245;es distintos de remodeladem&#44; com os militares a desenvolverem adapta&#231;&#245;es predominantemente exc&#234;ntricas e os basquetebolistas predominantemente conc&#234;ntricas&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es dos dados antropom&#233;tricos e sinais vitais ap&#243;s o curso militar&#47;&#233;poca desportiva foram mais significativas no grupo dos militares&#44; mesmo quando realizada uma suban&#225;lise &#40;<span class="elsevierStyleItalic">data not showed</span>&#41; comparando os militares com os atletas do g&#233;nero masculino e caucasianos&#46; Verificou&#8208;se uma expressiva transforma&#231;&#227;o da composi&#231;&#227;o corporal deste grupo&#44; com ganhos m&#233;dios de MM de 7&#44;5&#37; e elimina&#231;&#227;o m&#233;dia de MG de cerca de 30&#37;&#46; A diferen&#231;a nas adapta&#231;&#245;es entre as duas amostras analisadas podem estar relacionadas com a diferen&#231;a nas caracter&#237;sticas de exerc&#237;cio f&#237;sico entre o treino militar e o basquetebol&#46; Neste contexto&#44; destaca&#8208;se a maior carga hor&#225;ria de treino f&#237;sico e intensidade do treino militar&#44; bem como as particularidades da metodologia usada&#44; provavelmente justificando as adapta&#231;&#245;es mais marcadas nos militares&#46; Est&#225; demonstrado que com o treino intervalado de alta intensidade&#44; neste caso praticado pelos militares&#44; se conseguem melhores resultados e maiores adapta&#231;&#245;es<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#46; O mecanismo subjacente por estas adapta&#231;&#245;es ainda n&#227;o est&#225; clarificado&#44; mas pensa&#8208;se que este tipo de treino se relaciona com aumento da capacidade do metabolismo aer&#243;bico&#44; ana&#233;robico&#44; e atividade oxidativa enzim&#225;tica<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&#46; Apesar de em ambos os grupos n&#227;o existir hipertens&#227;o arterial&#44; nos militares a pr&#225;tica de exerc&#237;cio f&#237;sico intenso mostrou redu&#231;&#245;es de cerca de 4 e 9&#37; na PAS e PAD&#44; respetivamente&#46; Estes resultados correspondem ao que est&#225; descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">A remodelagem card&#237;aca esteve presente em ambos os grupos&#44; mas com caracter&#237;sticas distintas&#46; Nos militares existiu uma remodelagem exc&#234;ntrica&#44; com aumento das dimens&#245;es das cavidades esquerdas e diminui&#231;&#227;o da ERP&#44; duplicando no final do curso a propor&#231;&#227;o de militares com hipertrofia ventricular exc&#234;ntrica&#44; de 5&#44;9 para 11&#44;8&#37;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46; No grupo dos basquetebolistas foi observada uma remodelagem predominantemente conc&#234;ntrica&#44; com aumento das paredes do VE&#44; nomeadamente do SIV&#44; aumento da ERP e ligeira diminui&#231;&#227;o do DDVE&#46; Uma hip&#243;tese para explicar estes diferentes tipos de remodelagem card&#237;aca prende&#8208;se com a intensidade do exerc&#237;cio praticado&#46; Exerc&#237;cio f&#237;sico de intensidade moderada a vigorosa associa&#8208;se&#44; inicialmente&#44; a hipertrofia conc&#234;ntrica devido ao est&#237;mulo da sobrecarga de press&#227;o<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a>&#46; Exerc&#237;cios de intensidade vigorosa a quase m&#225;xima ou m&#225;xima est&#227;o relacionados com remodelagem de carater&#237;sticas exc&#234;ntricas&#44; devido &#224; sobrecarga de volume decorrente do aumento do d&#233;bito card&#237;aco&#44; resultante da eleva&#231;&#227;o da FC e dos volumes de eje&#231;&#227;o&#44; comparativamente a um aumento apenas moderado da PA<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; O aumento moderado da PA parece estar associado ao relaxamento do endot&#233;lio&#44; na depend&#234;ncia da acetilcolina&#44; que atinge o <span class="elsevierStyleItalic">plateau</span> com n&#237;veis de exerc&#237;cio moderado a vigoroso<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a>&#46; Deste modo&#44; quando o exerc&#237;cio passa de n&#237;vel de intensidade vigorosa para intensidade quase m&#225;xima ou m&#225;xima&#44; assiste&#8208;se a um aumento superior do d&#233;bito card&#237;aco&#44; n&#227;o acompanhado proporcionalmente do aumento da PA&#44; podendo originar uma dilata&#231;&#227;o das cavidades card&#237;acas desproporcional &#224; hipertrofia das paredes&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Apesar das adapta&#231;&#245;es observadas ao longo do curso&#47;&#233;poca desportiva&#44; verificou&#8208;se que estas ainda estavam situadas no limite superior da normalidade &#40;nenhum atleta com SIV<span class="elsevierStyleHsp" style=""></span>&#62;13<span class="elsevierStyleHsp" style=""></span>mm e apenas um com DDVE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm &#91;61&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#93;&#41;&#46; Relativamente aos par&#226;metros que avaliam a fun&#231;&#227;o diast&#243;lica&#44; verificou&#8208;se que n&#227;o houve altera&#231;&#245;es estatisticamente significativas durante o estudo&#44; no entanto &#233; de real&#231;ar que tanto os militares como os atletas j&#225; apresentam valores supranormais&#44; facto j&#225; descrito em popula&#231;&#245;es semelhantes<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Os par&#226;metros funcionais tamb&#233;m se alteraram com o exerc&#237;cio f&#237;sico de modo distinto nos dois grupos&#46; Nos militares verificou&#8208;se uma diminui&#231;&#227;o da FEVE em repouso&#44; enquanto nos basquetebolistas este par&#226;metro manteve&#8208;se com valores sobrepon&#237;veis aos basais&#46; Na literatura est&#225; descrito que atletas de elite&#44; sujeitos a esfor&#231;os muito intensos e prolongados&#44; podem apresentar ligeira diminui&#231;&#227;o da FEVE em repouso&#44; com valores m&#233;dios situados entre os 50&#8208;55&#37;&#44; aumentando apropriadamente quando solicitado pelo esfor&#231;o<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; No grupo dos militares&#44; nenhum indiv&#237;duo tinha na avalia&#231;&#227;o ecocardiogr&#225;fica inicial ou final a FEVE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no entanto&#44; 12 militares &#40;70&#37; desta popula&#231;&#227;o&#41; apresentavam no ETT final&#44; FEVE 50&#8208;55&#37;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Relativamente &#224; DLG&#44; verificou&#8208;se que tanto os militares como os basquetebolistas apresentavam valores dentro da normalidade<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#44; com uma tend&#234;ncia para diminuir ap&#243;s o programa de exerc&#237;cio f&#237;sico&#46; No nosso estudo&#44; esta diminui&#231;&#227;o n&#227;o foi significativa&#44; quando analisados os dois grupos separadamente&#44; mas quando comparados em conjunto a DLG decresceu significativamente&#46; Este comportamento do DLG est&#225; de acordo com o descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#44; podendo representar uma adapta&#231;&#227;o fisiol&#243;gica induzida pelo exerc&#237;cio f&#237;sico&#44; correspondendo a mais um par&#226;metro caracter&#237;stico do &#171;cora&#231;&#227;o de atleta&#187; e diferenciador da patologia card&#237;aca&#44; nomeadamente da miocardiopatia hipertr&#243;fica<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Contudo&#44; a atual escassez de dados nesta &#225;rea justifica a realiza&#231;&#227;o futura de estudos desenhados para estudar o efeito do exerc&#237;cio f&#237;sico neste par&#226;metro espec&#237;fico&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Limita&#231;&#245;es</span><p id="par0245" class="elsevierStylePara elsevierViewall">A principal limita&#231;&#227;o deste estudo relaciona&#8208;se com a reduzida dimens&#227;o das amostras analisadas&#44; tanto de militares de tropas especiais como de atletas&#46; Por outro lado&#44; a heterogeneidade das popula&#231;&#245;es quanto ao g&#233;nero e ra&#231;a limita tamb&#233;m os resultados&#44; justificada principalmente pela aus&#234;ncia de participa&#231;&#227;o de militares do g&#233;nero feminino neste curso de for&#231;as especiais&#46; Outra limita&#231;&#227;o prende&#8208;se com a incapacidade de quantificar objetivamente o exerc&#237;cio f&#237;sico n&#227;o programado praticado pelos militares durante o curso&#46; Estes indiv&#237;duos est&#227;o permanentemente envolvidos em atividades e avalia&#231;&#245;es&#44; nas quais a componente f&#237;sica &#233; fulcral&#44; mesmo n&#227;o praticando exerc&#237;cio f&#237;sico convencional ou programado&#46; Por fim&#44; apesar de todos os participantes negarem veementemente a toma de subst&#226;ncias estimulantes&#44; no protocolo do estudo&#44; tal n&#227;o foi comprovado&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclus&#227;o</span><p id="par0250" class="elsevierStylePara elsevierViewall">Neste estudo&#44; verificou&#8208;se uma remodelagem antropom&#233;trica e cardiovascular tanto nos militares de for&#231;as especiais como em basquetebolistas de n&#237;vel competitivo&#44; ap&#243;s o curso militar ou &#233;poca desportiva&#46; Essa remodelagem apresentou carater&#237;sticas distintas&#44; nos militares de predom&#237;nio exc&#234;ntrico e nos basquetebolistas conc&#234;ntrico&#46; As novas modalidades ecocardiogr&#225;ficas&#44; nomeadamente a an&#225;lise da deforma&#231;&#227;o mioc&#225;rdica&#44; podem revelar um padr&#227;o tamb&#233;m compat&#237;vel com adapta&#231;&#227;o fisiol&#243;gica ao exerc&#237;cio f&#237;sico&#44; podendo contribuir para a diferencia&#231;&#227;o entre &#171;cora&#231;&#227;o de atleta&#187; e patologia card&#237;aca&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Responsabilidades &#233;ticas</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Prote&#231;&#227;o de pessoas e animais</span><p id="par0255" 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="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Confidencialidade dos dados</span><p id="par0260" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Direito &#224; privacidade e consentimento escrito</span><p id="par0265" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflito de interesses</span><p id="par0270" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico &#233; frequente em atletas&#46; Esta adapta&#231;&#227;o manifesta&#8208;se a n&#237;vel estrutural com o aumento das dimens&#245;es e massa card&#237;acas&#46; Os militares tamb&#233;m s&#227;o sujeitos a exerc&#237;cio f&#237;sico intenso&#44; com especificidades distintas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar a remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico em atletas de competi&#231;&#227;o e pelo treino militar em militares a frequentar um curso de for&#231;as especiais&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Metodologia</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estud&#225;mos 17 militares &#40;g&#233;nero masculino e caucasianos&#44; idade m&#233;dia 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 anos&#41; que ingressaram no curso de Comandos e 17 basquetebolistas &#40;47&#44;3&#37; do g&#233;nero masculino&#44; 64&#44;7&#37; caucasianos&#44; idade m&#233;dia 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 anos&#41;&#46; A avalia&#231;&#227;o incluiu um ecocardiograma transtor&#225;cico com an&#225;lise da mec&#226;nica mioc&#225;rdica&#46; Esta avalia&#231;&#227;o foi realizada no in&#237;cio e no final do curso militar e da &#233;poca desportiva&#44; respetivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca teve caracter&#237;sticas distintas&#58; os militares apresentaram um padr&#227;o predominantemente exc&#234;ntrico&#44; com aumento das dimens&#245;es do ventr&#237;culo esquerdo &#40;49&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2 <span class="elsevierStyleItalic">versus</span> 52&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e da massa &#40;93&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;7 <span class="elsevierStyleItalic">versus</span> 100&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4<span class="elsevierStyleHsp" style=""></span>g&#47;m<span class="elsevierStyleSup">2</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e diminui&#231;&#227;o da espessura relativa das paredes &#40;0&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#59; os basquetebolistas apresentaram um padr&#227;o conc&#234;ntrico&#44; com diminui&#231;&#227;o das dimens&#245;es do ventr&#237;culo esquerdo &#40;52&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 <span class="elsevierStyleItalic">versus</span> 50&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e da espessura relativa das paredes &#40;0&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Apesar da deforma&#231;&#227;o mioc&#225;rdica global do ventr&#237;culo esquerdo n&#227;o apresentar diferen&#231;as significativas entre os grupos&#44; quando analisados em conjunto o seu valor diminuiu &#40;&#8208;20&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&#37; <span class="elsevierStyleItalic">versus</span> &#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca foi frequente&#44; com padr&#227;o exc&#234;ntrico nos militares e conc&#234;ntrico nos atletas&#46; A mec&#226;nica mioc&#225;rdica poder&#225; representar uma adapta&#231;&#227;o fisiol&#243;gica induzida pelo exerc&#237;cio f&#237;sico&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Exercise&#8208;induced cardiac remodeling is frequent in athletes&#46; This adaptation is structurally manifested by an increase in cardiac dimensions and mass&#46; Soldiers are also subject to intense physical exercise&#44; although with different characteristics&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">To compare exercise&#8208;induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">We studied 17 soldiers &#40;all male and Caucasian&#44; mean age 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41; who completed a special forces course and 17 basketball players &#40;47&#46;3&#37; male&#44; 64&#46;7&#37; Caucasian&#44; mean age 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41;&#46; Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics&#46; This assessment was performed at the beginning and end of the military course and the sports season&#44; respectively&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Cardiac remodeling was observed in both groups&#46; The soldiers presented a predominantly eccentric pattern&#44; with increased left ventricular &#40;LV&#41; size &#40;49&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2 vs&#46; 52&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; increased LV mass &#40;93&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;7 vs&#46; 100&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;4 g&#47;m2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and decreased relative wall thickness &#40;0&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1 vs&#46; 0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The basketball players showed a concentric pattern&#44; with decreased LV size &#40;52&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7 vs&#46; 50&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7 mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and increased relative wall thickness &#40;0&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1 vs&#46; 0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Although there was no significant difference in LV myocardial strain in the groups separately&#44; when compared there was a significant decrease &#40;&#8208;20&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&#37; vs&#46; &#8208;19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Cardiac remodeling was frequent&#44; with an eccentric pattern in soldiers and a concentric pattern in basketball players&#46; Myocardial deformation may represent a physiological adaptation to physical exercise&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\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">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \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">PAD &#40;mm Hg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
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                  \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">FC &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        ]
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col"><br>Par&#226;metros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\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">Final&nbsp;\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 valor&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Remodelagem cardíaca induzida pelo exercício físico em atletas de nível competitivo e militares de forças especiais
Exercise‐induced cardiac remodeling in athletes and in special forces soldiers
Paulo Dinisa,b,
Autor para correspondência
paulogdinis@gmail.com

Autor para correspondência.
, Rogério Teixeiraa,c, Hélder Doresd, Pedro Correiaa,b, Hanna Lekedale, Marie Bergmane, Maria Carmo Cachuloa, Joaquim Cardosob, Lino Gonçalvesa,c
a Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra – Hospital Geral, Coimbra, Portugal
b Centro de Saúde Militar de Coimbra, Coimbra, Portugal
c Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
d Hospital das Forças Armadas, Lisboa, Portugal
e University of Linköping, Linköping, Sweden
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introdu&#231;&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O exerc&#237;cio f&#237;sico intenso e prolongado condiciona adapta&#231;&#245;es card&#237;acas fisiol&#243;gicas conhecidas por &#171;cora&#231;&#227;o de atleta&#187;&#46; Entre estas altera&#231;&#245;es destacam&#8208;se o aumento das dimens&#245;es&#44; volumes e massa card&#237;acas e a melhoria de par&#226;metros funcionais&#44; nomeadamente da fun&#231;&#227;o diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; Tradicionalmente&#44; existem dois tipos de remodelagem card&#237;aca&#58; remodelagem conc&#234;ntrica associada a exerc&#237;cio est&#225;tico e exc&#234;ntrica associada a exerc&#237;cio din&#226;mico<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a>&#46; Por exemplo&#44; os maratonistas apresentam remodelagem exc&#234;ntrica pela sobrecarga de volume resultante do aumento do d&#233;bito card&#237;aco&#44; enquanto os halterofilistas apresentam remodelagem conc&#234;ntrica pela sobrecarga de press&#227;o<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a>&#46; De real&#231;ar que esta subdivis&#227;o n&#227;o dever&#225; ser estanque&#44; porque a maioria das modalidades desportivas t&#234;m influ&#234;ncias de ambos os tipos de exerc&#237;cio &#8211; isom&#233;trico e isot&#243;nico&#44; o que condicionar&#225; uma remodelagem com caracter&#237;sticas mistas<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No entanto&#44; os atletas n&#227;o s&#227;o os &#250;nicos indiv&#237;duos a estarem sujeitos a treinos de elevada intensidade&#46; Os militares constituem outro exemplo&#44; particularmente as for&#231;as especiais&#44; com uma exigente forma&#231;&#227;o a n&#237;vel f&#237;sico&#44; caracterizada por m&#250;ltiplas modalidades dos dois tipos de exerc&#237;cio&#46; Estes militares podem ser globalmente equiparados a atletas de n&#237;vel competitivo&#44; muitas vezes at&#233; com volumes de exerc&#237;cio superiores&#46; Contudo&#44; o treino militar apresenta algumas particularidades&#44; desde as metodologias utilizadas &#224; influ&#234;ncia de m&#250;ltiplas vari&#225;veis inerentes &#224; condi&#231;&#227;o militar<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico pode manifestar&#8208;se com caracter&#237;sticas sobrepostas a achados presentes em situa&#231;&#245;es patol&#243;gicas&#44; nomeadamente miocardiopatias&#44; sendo muitas vezes desafiante o seu diagn&#243;stico diferencial<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#46; Neste &#226;mbito&#44; a avalia&#231;&#227;o pr&#233;&#8208;competitiva de atletas e a interpreta&#231;&#227;o dos exames complementares de diagn&#243;stico realizados nesta popula&#231;&#227;o reveste&#8208;se de enorme import&#226;ncia&#46; Na &#250;ltima d&#233;cada foram desenvolvidas novas metodologias imagiol&#243;gicas que permitem uma avalia&#231;&#227;o mioc&#225;rdica pormenorizada&#44; como a an&#225;lise da mec&#226;nica mioc&#225;rdica por ecocardiografia transtor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Os objetivos principais deste trabalho foram caracterizar e comparar a remodelagem card&#237;aca em atletas profissionais de basquetebol ao longo de uma &#233;poca desportiva e em militares num curso de for&#231;as especiais&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Metodologia</span><p id="par0130" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; longitudinal de caso&#8208;controlo&#44; em que foram avaliados militares de for&#231;as especiais e atletas de alta competi&#231;&#227;o no in&#237;cio e no fim do curso militar e de uma &#233;poca desportiva&#44; respetivamente&#46; Foram inclu&#237;dos indiv&#237;duos &#40;militares ou atletas&#41; do g&#233;nero masculino ou feminino&#44; com idades entre os 18&#8208;35 anos&#46; Os militares foram selecionados entre aqueles que ingressaram num curso de Comandos do Ex&#233;rcito Portugu&#234;s&#44; sendo avaliados entre janeiro e junho de 2016&#46; Os atletas pertenciam a duas equipas de basquetebol profissional&#44; uma masculina e outra feminina&#44; competindo na 1&#46;&#170; divis&#227;o masculina&#47;liga feminina a n&#237;vel nacional&#44; tendo sido avaliados em outubro de 2015 e mar&#231;o&#47;abril de 2016&#46; Portanto&#44; ambos os grupos foram avaliados com cerca de seis meses de intervalo&#46; A popula&#231;&#227;o de militares&#44; inicialmente composta por 76 formandos&#44; englobou 17 militares&#44; correspondendo aos que conclu&#237;ram o curso com sucesso e preencheram os crit&#233;rios de inclus&#227;o &#40;taxa de desist&#234;ncia aproximada de 70&#37;&#44; 54 instruendos&#41;&#46; Todos estes militares tinham hist&#243;ria pr&#233;via de pr&#225;tica de desporto em n&#237;vel competitivo&#46; A popula&#231;&#227;o de atletas correspondeu a 17 basquetebolistas&#44; oito do g&#233;nero masculino e nove do feminino&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Todos os ind&#237;viduos foram volunt&#225;rios e deram o seu consentimento informado para participarem no estudo&#46; O protocolo foi aprovado pela Comiss&#227;o de &#201;tica da Faculdade de Medicina da Universidade de Coimbra &#40;protocolo de refer&#234;ncia &#8211; 087&#47;2015&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Caracter&#237;sticas do exerc&#237;cio f&#237;sico da popula&#231;&#227;o estudada</span><p id="par0140" class="elsevierStylePara elsevierViewall">O curso de Comandos caracteriza&#8208;se por exerc&#237;cio f&#237;sico de elevada intensidade&#44; com os objetivos de desenvolver a capacidade aer&#243;bica e anaer&#243;bica&#46; Para este fim&#44; os militares s&#227;o sujeitos a treino f&#237;sico din&#226;mico e est&#225;tico&#44; englobando v&#225;rias modalidades desportivas como atletismo&#44; nata&#231;&#227;o&#44; gin&#225;stica&#44; levantamento de pesos&#44; entre outros&#46; Para al&#233;m destes exerc&#237;cios&#44; s&#227;o sujeitos a treino f&#237;sico de aplica&#231;&#227;o militar cujo objetivo &#233; adquirir e desenvolver t&#233;cnicas e capacidades psicomotoras que permitam ao militar desempenhar as suas fun&#231;&#245;es em condi&#231;&#245;es adversas&#46; Este treino f&#237;sico de aplica&#231;&#227;o militar consiste na realiza&#231;&#227;o de pistas de obst&#225;culos&#44; corridas intensas intercaladas com marcha&#44; transporte de cargas&#44; entre outras atividades&#46; O programa de treino do curso foi realizado em duas fases&#58; primeira fase &#8211; dez semanas com exerc&#237;cio f&#237;sico de intensidade vigorosa &#40;77&#8208;95&#37; da frequ&#234;ncia card&#237;aca &#91;FC&#93; m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#44; frequ&#234;ncia de cinco vezes&#47;semana e dura&#231;&#227;o m&#233;dia de quatro horas&#47;dia&#59; segunda fase &#8211; 15 semanas com exerc&#237;cio f&#237;sico de intensidade vigorosa &#40;77&#8208;95&#37; da FC m&#225;xima&#41; intercalado com per&#237;odos de exerc&#237;cio de intensidade quase m&#225;ximo ou m&#225;ximo &#40;&#62;<span class="elsevierStyleHsp" style=""></span>96&#37; da FC m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#44; frequ&#234;ncia de cinco vezes&#47;semana e dura&#231;&#227;o m&#233;dia de quatro horas&#47;dia&#46; Para al&#233;m deste treino programado&#44; estes militares est&#227;o sob permanente desgaste f&#237;sico&#44; psicol&#243;gico e emocional&#44; de dif&#237;cil quantifica&#231;&#227;o&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O basquetebol engloba uma multiplicidade de movimentos&#44; realizados com base na velocidade&#44; habilidade e for&#231;a&#44; requerendo exerc&#237;cios din&#226;micos e est&#225;ticos&#44; com uma componente geral e outra espec&#237;fica&#46; A componente geral &#233; trabalhada com corrida cont&#237;nua&#44; velocidade e mudan&#231;as de dire&#231;&#227;o&#44; exerc&#237;cios de gin&#225;stica e flexibilidade&#46; A componente espec&#237;fica engloba&#44; sobretudo&#44; treino de coordena&#231;&#227;o com aprendizagem e aperfei&#231;oamento de gestos t&#233;cnicos&#46; Os atletas treinam quatro vezes&#47;semana e t&#234;m um jogo por semana&#44; sendo a dura&#231;&#227;o m&#233;dia de cada treino cerca de tr&#234;s horas&#44; com tr&#234;s per&#237;odos distintos&#58; aquecimento&#44; treino de basquetebol com exerc&#237;cios gerais e espec&#237;ficos&#44; e retorno &#224; calma&#46; O basquetebol tem per&#237;odos em que os atletas s&#227;o sujeitos a intensidade de vigorosa a quase m&#225;xima&#44; com outros de intensidade baixa a moderada&#46; Globalmente&#44; os treinos destes atletas enquadravam&#8208;se no n&#237;vel de intensidade vigorosa &#40;77&#8208;95&#37; da FC m&#225;xima&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Avalia&#231;&#227;o cl&#237;nica</span><p id="par0150" class="elsevierStylePara elsevierViewall">Todos os participantes foram submetidos a um exame f&#237;sico completo e hist&#243;ria cl&#237;nica rigorosa&#44; realizada por um m&#233;dico de medicina desportiva ou de cardiologia&#46; Enfatizou&#8208;se a pesquisa de fatores de risco cardiovasculares &#40;FRCV&#41;&#44; os h&#225;bitos alimentares e farmacol&#243;gicos&#44; e a hist&#243;ria desportiva&#44; incluindo o n&#250;mero de horas de treino e de sono durante o curso&#47; &#233;poca desportiva&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Avalia&#231;&#227;o antropom&#233;trica</span><p id="par0155" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o antropom&#233;trica foi realizada por um enfermeiro e um t&#233;cnico superior de sa&#250;de&#46; A altura foi avaliada atrav&#233;s de uma fita m&#233;trica&#44; enquanto o peso&#44; percentagem de massa gorda &#40;MG&#41; e massa muscular &#40;MM&#41; usando uma balan&#231;a digital de corpo inteiro com bioimped&#226;ncia &#40;HBF510W &#8208; OMRON<span class="elsevierStyleSup">&#174;</span>&#41;&#46; A medi&#231;&#227;o da press&#227;o arterial sist&#243;lica &#40;PAS&#41; e diast&#243;lica &#40;PAD&#41;&#44; e a FC foram avaliadas por um medidor de press&#227;o arterial &#40;PA&#41; de bra&#231;o &#40;HEM 7113 &#8208; OMRON<span class="elsevierStyleSup">&#174;</span>&#41;&#44; de acordo com as recomenda&#231;&#245;es atuais<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#46; Foram calculadas vari&#225;veis&#58; varia&#231;&#227;o &#40;&#916;&#41; peso&#44; &#916; MM&#44; &#916; MG&#59; &#916; PAS&#44; &#916; PAD pela seguinte f&#243;rmula&#58; &#40;par&#226;metro final &#8208; par&#226;metro inicial&#41; &#47; par&#226;metro inicial<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>100&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Avalia&#231;&#227;o eletrocardiogr&#225;fica</span><p id="par0160" class="elsevierStylePara elsevierViewall">Todos os indiv&#237;duos inclu&#237;dos realizaram eletrocardiograma &#40;ECG&#41; de 12 deriva&#231;&#245;es &#40;NORAV<span class="elsevierStyleSup">&#174;</span> modelo 1200HR&#41;&#44; analisados por dois cardiologistas e interpretados de acordo com os crit&#233;rios refinados<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Avalia&#231;&#227;o ecocardiogr&#225;fia</span><p id="par0165" class="elsevierStylePara elsevierViewall">Todos os ecocardiogramas transtor&#225;cios &#40;ETT&#41; foram realizados por um cardiologista com o ecocardi&#243;grafo Vivid 7&#44; GE Healthcare<span class="elsevierStyleSup">&#174;</span>&#44; englobando as diversas janelas ecocardiogr&#225;ficas e modalidades recomendadas pela Sociedade Europeia de Cardiologia &#40;bidimensional&#44; modo M&#44; <span class="elsevierStyleItalic">Doppler</span> cor&#44; pulsado&#44; cont&#237;nuo e tissular&#44; deforma&#231;&#227;o mioc&#225;rdica por <span class="elsevierStyleItalic">Speckle&#8208;Tracking&#41;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As medi&#231;&#245;es da espessura parietal e as dimens&#245;es do ventr&#237;culo esquerdo &#40;VE&#41; foram adquiridas em janela paraesternal eixo longo&#44; a espessura relativa das paredes &#40;ERP&#41; calculada pela f&#243;rmula &#40;2<span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span>parede posterior do VE &#91;PPVE&#93;&#47;di&#226;metro diast&#243;lico do VE &#91;DDVE&#93;&#41; e a massa VE pela f&#243;rmula de <span class="elsevierStyleItalic">Devereux&#39;s</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#46; O volume VE e da aur&#237;cula esquerda &#40;AE&#41; foi determinado pela regra de <span class="elsevierStyleItalic">Simpson</span> modificada&#44; com imagens obtidas em janela apical quatro e duas c&#226;maras&#46; O volume indexado da AE foi obtido por indexa&#231;&#227;o &#224; &#225;rea de superf&#237;cie corporal &#40;ASC&#41;&#46; A fra&#231;&#227;o de eje&#231;&#227;o VE &#40;FEVE&#41; foi determinada pelo m&#233;todo de <span class="elsevierStyleItalic">Simpson&#46;</span> O <span class="elsevierStyleItalic">Doppler</span> pulsado foi adquirido em janela apical quatro c&#226;maras&#44; sendo determinadas as velocidades de pico da onda <span class="elsevierStyleItalic">E</span>&#44; onda <span class="elsevierStyleItalic">A</span> e rela&#231;&#227;o <span class="elsevierStyleItalic">E&#47;A</span>&#46; As imagens do <span class="elsevierStyleItalic">Doppler</span> tecidular do anel mitral e tric&#250;spide foram obtidas para determinar as ondas <span class="elsevierStyleItalic">E</span> e <span class="elsevierStyleItalic">E&#8217;</span>&#44; e determinar as velocidades da onda <span class="elsevierStyleItalic">S&#8217;</span>&#44; respetivamente&#46; Por modo M determinou&#8208;se o plano de excurs&#227;o sist&#243;lica do anel tric&#250;spide &#40;TAPSE&#41;&#46; O <span class="elsevierStyleItalic">Speckle Tracking</span> utilizou&#8208;se para calcular a deforma&#231;&#227;o &#40;<span class="elsevierStyleItalic">strain</span>&#41; longitudinal global &#40;DLG&#41; do VE&#44; atrav&#233;s de imagens adquiridas em incid&#234;ncias apicais de quatro&#44; duas e tr&#234;s c&#226;maras&#44; representando um modelo mioc&#225;rdico de 18 segmentos&#46; A aquisic&#227;o dos ciclos card&#237;acos foi realizada durante a mesma fase respirat&#243;ria &#40;expira&#231;&#227;o&#41;&#44; sendo gravados tr&#234;s ciclos consecutivos e calculada a m&#233;dia para o ritmo sinusal&#44; com <span class="elsevierStyleItalic">frame rate</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60 <span class="elsevierStyleItalic">frames</span> por segundo&#46; A qualidade do exame foi considerada boa quando at&#233; no m&#225;ximo dois segmentos eram exclu&#237;dos&#44; e excelente quando todos os segmentos eram analisados&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a> exemplifica um ETT de um militar e de um atleta ap&#243;s o curso&#47;&#233;poca desportiva&#44; respetivamente&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lise estat&#237;stica</span><p id="par0180" class="elsevierStylePara elsevierViewall">As vari&#225;veis categ&#243;ricas foram apresentadas como frequ&#234;ncia e percentagem&#44; e os testes<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>e <span class="elsevierStyleItalic">Fisher</span> foram utilizados quando apropriados&#46; O teste <span class="elsevierStyleItalic">Kolmogorov&#8208;Smirnov</span> foi utilizado para verificar a distribui&#231;&#227;o das vari&#225;veis cont&#237;nuas&#46; As vari&#225;veis com distribui&#231;&#227;o normal foram expressas como m&#233;dia e desvio&#8208;padr&#227;o&#44; e o teste <span class="elsevierStyleItalic">T Student</span> foi utilizado para a compara&#231;&#227;o de grupos&#46; A homogeneidade das vari&#225;veis individuais foi avaliada pelo teste de <span class="elsevierStyleItalic">Levene</span>&#46; As vari&#225;veis com uma distribui&#231;&#227;o n&#227;o normal foram expressas como mediana e intervalos interquartil&#44; sendo os grupos comparados com os testes <span class="elsevierStyleItalic">Mann&#8208;Whitney</span> e <span class="elsevierStyleItalic">Kruskal&#8208;Wallis</span>&#46; A correla&#231;&#227;o de <span class="elsevierStyleItalic">Pearson</span> foi utilizada para analisar as associa&#231;&#245;es entre a MM e MG com os par&#226;metros ecocardiogr&#225;ficos&#46; Para todas as compara&#231;&#245;es o valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significativo&#44; com intervalo de confian&#231;a &#40;IC&#41; de 95&#37;&#46; Todos os dados foram calculados e analisados atrav&#233;s do programa SPSS&#44; vers&#227;o 20 &#40;SPSS<span class="elsevierStyleSup">&#174;</span> Inc&#46;&#44; Chicago&#44; IL&#44; EUA&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resultados</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Caracteriza&#231;&#227;o da popula&#231;&#227;o</span><p id="par0185" class="elsevierStylePara elsevierViewall">As carater&#237;sticas da popula&#231;&#227;o estudada est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46; Sucintamente&#44; destaca&#8208;se que os dois grupos tinham idades m&#233;dias id&#234;nticas&#44; havendo diferen&#231;a significativa quanto ao g&#233;nero e ra&#231;a caucasiana&#46; Os militares praticavam desporto de n&#237;vel competitivo h&#225; menos tempo e apresentavam um &#237;ndice de massa corporal &#40;IMC&#41; superior&#46; Durante o estudo os militares realizaram um n&#250;mero superior de horas de exerc&#237;cio programado por dia&#44; tiveram menos horas de descanso noturno e um menor n&#250;mero de refei&#231;&#245;es di&#225;rias&#46; Em rela&#231;&#227;o aos FRCV&#44; verificou&#8208;se que um quarto da popula&#231;&#227;o &#40;20&#44;6&#37;&#41; apresentava pelo menos um FRCV&#46; O tabagismo foi mais frequente e exclusivo nos militares &#40;17&#44;6&#37;&#41;&#44; seguido da dislipidemia&#44; tamb&#233;m mais frequente nesta popula&#231;&#227;o &#40;5&#44;9 <span class="elsevierStyleItalic">versus</span> 2&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;32&#41;&#46; A popula&#231;&#227;o n&#227;o apresentava hist&#243;ria familiar de doen&#231;a cardiovascular&#44; hipertens&#227;o arterial ou diabetes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Varia&#231;&#227;o dos dados antropom&#233;tricos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os militares tiveram um aumento significativo do peso corporal&#44; com aumento da MM e diminui&#231;&#227;o da MG&#44; PAS&#44; PAD e FC&#44; mais pronunciada que os basquetebolistas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; Analisando especificamente os indiv&#237;duos do g&#233;nero masculino&#44; estas altera&#231;&#245;es mantiveram&#8208;se para o aumento da percentagem de MM e diminui&#231;&#227;o da MG&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">A diferen&#231;a percentual na &#916; dos dados antropom&#233;tricos entre os dois grupos foi estatisticamente significativa para o peso&#44; PAS&#44; PAD&#44; MM e MG &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46; Verificou&#8208;se ganho de peso nos militares relativamente aos basquetebolistas &#40;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; com aumento da MM &#40;7&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1 <span class="elsevierStyleItalic">versus</span> 1&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e dimui&#231;&#227;o mais acentuada da MG &#40;&#8208;31&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;7 <span class="elsevierStyleItalic">versus</span> &#8208;0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Relativamente ao perfil tensional&#44; os militares tiveram redu&#231;&#227;o da PAS &#40;&#8208;4&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;0 <span class="elsevierStyleItalic">versus</span> 1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e da PAD &#40;&#8208;8&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 <span class="elsevierStyleItalic">versus</span> 1&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Avalia&#231;&#227;o eletrocardiogr&#225;fica</span><p id="par0200" class="elsevierStylePara elsevierViewall">Todos os ECG estavam em ritmo sinusal e foram considerados normais ou apenas com altera&#231;&#245;es fisiol&#243;gicas&#46; A altera&#231;&#227;o fisiol&#243;gica mais frequente foi a bradicardia sinusal &#40;41&#44;2&#37;&#41;&#44; seguida da repolariza&#231;&#227;o precoce &#40;29&#44;4&#37;&#41;&#44; hipertrofia do VE &#40;20&#44;6&#37;&#41;&#44; bloqueio incompleto do ramo direito &#40;11&#44;8&#37;&#41; e bloqueio aur&#237;culo ventricular de 1&#46;&#176; grau &#40;2&#44;9&#37;&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Avalia&#231;&#227;o ecocardiogr&#225;fica</span><p id="par0205" class="elsevierStylePara elsevierViewall">O ETT revelou diferentes padr&#245;es de remodelagem card&#237;aca estrutural &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; Nos militares verificou&#8208;se aumento das dimens&#245;es das cavidades esquerdas&#44; tanto do VE &#40;49&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2 <span class="elsevierStyleItalic">versus</span> 52&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; como da AE &#40;63&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5 <span class="elsevierStyleItalic">versus</span> 71&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1<span class="elsevierStyleHsp" style=""></span>mL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e diminui&#231;&#227;o da ERP &#40;0&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Nos atletas verificou&#8208;se diminui&#231;&#227;o das dimens&#245;es do VE &#40;52&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 <span class="elsevierStyleItalic">versus</span> 50&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; aumento do septo interventricular &#40;SIV&#41; &#40;8&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 <span class="elsevierStyleItalic">versus</span> 9&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e aumento da ERP &#40;0&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Relativamente aos par&#226;metros funcionais&#44; nos militares verificou&#8208;se uma redu&#231;&#227;o da FEVE em repouso &#40;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 <span class="elsevierStyleItalic">versus</span> 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e aumento da onda S&#8217;&#44; tanto nos militares &#40;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 <span class="elsevierStyleItalic">versus</span> 17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; como nos basquetebolistas &#40;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 <span class="elsevierStyleItalic">versus</span> 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">Quando avaliados separadamente os indiv&#237;duos do g&#233;nero masculino&#44; mantiveram&#8208;se os diferentes tipos de remodelagem descritos previamente&#44; existindo diferen&#231;a significativa no volume AE &#40;51&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1 <span class="elsevierStyleItalic">versus</span> 58&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;9<span class="elsevierStyleHsp" style=""></span>mL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e DLG &#40;&#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;17&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; nos basquetebolistas&#46; Apesar de a DLG n&#227;o apresentar diferen&#231;as significativas nos dois grupos no in&#237;cio e no fim do curso&#47;&#233;poca desportiva&#44; verificou&#8208;se uma diferen&#231;a significativa quando se estudaram os dois grupos em conjunto &#40;&#8208;20&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&#37; <span class="elsevierStyleItalic">versus</span> &#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; As diferen&#231;as percentuais relativas aos achados ecocardiogr&#225;ficos obtidos nos dois grupos mostraram diferen&#231;as na dimens&#227;o diast&#243;lica do VE&#44; ERP&#44; FEVE e onda S&#8217; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#46; As altera&#231;&#245;es relacionadas com a ERP e a dimens&#227;o diast&#243;lica do VE foram contr&#225;rias&#44; com os militares a diminu&#237;rem o valor da ERP em percentagem &#40;&#8208;10&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;3 <span class="elsevierStyleItalic">versus</span> 12&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e a aumentarem o DDVE &#40;6&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; enquanto nos basquetebolistas a ERP aumentou e o DDVE diminuiu durante a &#233;poca desportiva&#46; Estes dados s&#227;o semelhantes quando se comparam apenas militares e basquetebolistas do g&#233;nero masculino&#44; com diferen&#231;as percentuais significativas na ERP &#40;&#8208;10&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;3 <span class="elsevierStyleItalic">versus</span> 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; DDVE &#40;6&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3 <span class="elsevierStyleItalic">versus</span> &#8208;3&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e FEVE &#40;&#8208;5&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;8 <span class="elsevierStyleItalic">versus</span> 4&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discuss&#227;o</span><p id="par0215" class="elsevierStylePara elsevierViewall">Este estudo demonstrou a exist&#234;ncia de remodelagem antropom&#233;trica e cardiovascular nos militares e nos basquetebolistas&#46; Estas adapta&#231;&#245;es tiveram carater&#237;sticas distintas nos dois grupos&#46; Relativamente aos dados antropom&#233;tricos&#44; os militares tiveram um aumento mais marcado do peso corporal&#44; com ganhos de MM e diminui&#231;&#227;o de MG&#46; A avalia&#231;&#227;o ecocardiogr&#225;fica revelou padr&#245;es distintos de remodeladem&#44; com os militares a desenvolverem adapta&#231;&#245;es predominantemente exc&#234;ntricas e os basquetebolistas predominantemente conc&#234;ntricas&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es dos dados antropom&#233;tricos e sinais vitais ap&#243;s o curso militar&#47;&#233;poca desportiva foram mais significativas no grupo dos militares&#44; mesmo quando realizada uma suban&#225;lise &#40;<span class="elsevierStyleItalic">data not showed</span>&#41; comparando os militares com os atletas do g&#233;nero masculino e caucasianos&#46; Verificou&#8208;se uma expressiva transforma&#231;&#227;o da composi&#231;&#227;o corporal deste grupo&#44; com ganhos m&#233;dios de MM de 7&#44;5&#37; e elimina&#231;&#227;o m&#233;dia de MG de cerca de 30&#37;&#46; A diferen&#231;a nas adapta&#231;&#245;es entre as duas amostras analisadas podem estar relacionadas com a diferen&#231;a nas caracter&#237;sticas de exerc&#237;cio f&#237;sico entre o treino militar e o basquetebol&#46; Neste contexto&#44; destaca&#8208;se a maior carga hor&#225;ria de treino f&#237;sico e intensidade do treino militar&#44; bem como as particularidades da metodologia usada&#44; provavelmente justificando as adapta&#231;&#245;es mais marcadas nos militares&#46; Est&#225; demonstrado que com o treino intervalado de alta intensidade&#44; neste caso praticado pelos militares&#44; se conseguem melhores resultados e maiores adapta&#231;&#245;es<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#46; O mecanismo subjacente por estas adapta&#231;&#245;es ainda n&#227;o est&#225; clarificado&#44; mas pensa&#8208;se que este tipo de treino se relaciona com aumento da capacidade do metabolismo aer&#243;bico&#44; ana&#233;robico&#44; e atividade oxidativa enzim&#225;tica<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&#46; Apesar de em ambos os grupos n&#227;o existir hipertens&#227;o arterial&#44; nos militares a pr&#225;tica de exerc&#237;cio f&#237;sico intenso mostrou redu&#231;&#245;es de cerca de 4 e 9&#37; na PAS e PAD&#44; respetivamente&#46; Estes resultados correspondem ao que est&#225; descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">A remodelagem card&#237;aca esteve presente em ambos os grupos&#44; mas com caracter&#237;sticas distintas&#46; Nos militares existiu uma remodelagem exc&#234;ntrica&#44; com aumento das dimens&#245;es das cavidades esquerdas e diminui&#231;&#227;o da ERP&#44; duplicando no final do curso a propor&#231;&#227;o de militares com hipertrofia ventricular exc&#234;ntrica&#44; de 5&#44;9 para 11&#44;8&#37;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46; No grupo dos basquetebolistas foi observada uma remodelagem predominantemente conc&#234;ntrica&#44; com aumento das paredes do VE&#44; nomeadamente do SIV&#44; aumento da ERP e ligeira diminui&#231;&#227;o do DDVE&#46; Uma hip&#243;tese para explicar estes diferentes tipos de remodelagem card&#237;aca prende&#8208;se com a intensidade do exerc&#237;cio praticado&#46; Exerc&#237;cio f&#237;sico de intensidade moderada a vigorosa associa&#8208;se&#44; inicialmente&#44; a hipertrofia conc&#234;ntrica devido ao est&#237;mulo da sobrecarga de press&#227;o<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a>&#46; Exerc&#237;cios de intensidade vigorosa a quase m&#225;xima ou m&#225;xima est&#227;o relacionados com remodelagem de carater&#237;sticas exc&#234;ntricas&#44; devido &#224; sobrecarga de volume decorrente do aumento do d&#233;bito card&#237;aco&#44; resultante da eleva&#231;&#227;o da FC e dos volumes de eje&#231;&#227;o&#44; comparativamente a um aumento apenas moderado da PA<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; O aumento moderado da PA parece estar associado ao relaxamento do endot&#233;lio&#44; na depend&#234;ncia da acetilcolina&#44; que atinge o <span class="elsevierStyleItalic">plateau</span> com n&#237;veis de exerc&#237;cio moderado a vigoroso<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a>&#46; Deste modo&#44; quando o exerc&#237;cio passa de n&#237;vel de intensidade vigorosa para intensidade quase m&#225;xima ou m&#225;xima&#44; assiste&#8208;se a um aumento superior do d&#233;bito card&#237;aco&#44; n&#227;o acompanhado proporcionalmente do aumento da PA&#44; podendo originar uma dilata&#231;&#227;o das cavidades card&#237;acas desproporcional &#224; hipertrofia das paredes&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Apesar das adapta&#231;&#245;es observadas ao longo do curso&#47;&#233;poca desportiva&#44; verificou&#8208;se que estas ainda estavam situadas no limite superior da normalidade &#40;nenhum atleta com SIV<span class="elsevierStyleHsp" style=""></span>&#62;13<span class="elsevierStyleHsp" style=""></span>mm e apenas um com DDVE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm &#91;61&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#93;&#41;&#46; Relativamente aos par&#226;metros que avaliam a fun&#231;&#227;o diast&#243;lica&#44; verificou&#8208;se que n&#227;o houve altera&#231;&#245;es estatisticamente significativas durante o estudo&#44; no entanto &#233; de real&#231;ar que tanto os militares como os atletas j&#225; apresentam valores supranormais&#44; facto j&#225; descrito em popula&#231;&#245;es semelhantes<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Os par&#226;metros funcionais tamb&#233;m se alteraram com o exerc&#237;cio f&#237;sico de modo distinto nos dois grupos&#46; Nos militares verificou&#8208;se uma diminui&#231;&#227;o da FEVE em repouso&#44; enquanto nos basquetebolistas este par&#226;metro manteve&#8208;se com valores sobrepon&#237;veis aos basais&#46; Na literatura est&#225; descrito que atletas de elite&#44; sujeitos a esfor&#231;os muito intensos e prolongados&#44; podem apresentar ligeira diminui&#231;&#227;o da FEVE em repouso&#44; com valores m&#233;dios situados entre os 50&#8208;55&#37;&#44; aumentando apropriadamente quando solicitado pelo esfor&#231;o<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; No grupo dos militares&#44; nenhum indiv&#237;duo tinha na avalia&#231;&#227;o ecocardiogr&#225;fica inicial ou final a FEVE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no entanto&#44; 12 militares &#40;70&#37; desta popula&#231;&#227;o&#41; apresentavam no ETT final&#44; FEVE 50&#8208;55&#37;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Relativamente &#224; DLG&#44; verificou&#8208;se que tanto os militares como os basquetebolistas apresentavam valores dentro da normalidade<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#44; com uma tend&#234;ncia para diminuir ap&#243;s o programa de exerc&#237;cio f&#237;sico&#46; No nosso estudo&#44; esta diminui&#231;&#227;o n&#227;o foi significativa&#44; quando analisados os dois grupos separadamente&#44; mas quando comparados em conjunto a DLG decresceu significativamente&#46; Este comportamento do DLG est&#225; de acordo com o descrito na literatura<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#44; podendo representar uma adapta&#231;&#227;o fisiol&#243;gica induzida pelo exerc&#237;cio f&#237;sico&#44; correspondendo a mais um par&#226;metro caracter&#237;stico do &#171;cora&#231;&#227;o de atleta&#187; e diferenciador da patologia card&#237;aca&#44; nomeadamente da miocardiopatia hipertr&#243;fica<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Contudo&#44; a atual escassez de dados nesta &#225;rea justifica a realiza&#231;&#227;o futura de estudos desenhados para estudar o efeito do exerc&#237;cio f&#237;sico neste par&#226;metro espec&#237;fico&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Limita&#231;&#245;es</span><p id="par0245" class="elsevierStylePara elsevierViewall">A principal limita&#231;&#227;o deste estudo relaciona&#8208;se com a reduzida dimens&#227;o das amostras analisadas&#44; tanto de militares de tropas especiais como de atletas&#46; Por outro lado&#44; a heterogeneidade das popula&#231;&#245;es quanto ao g&#233;nero e ra&#231;a limita tamb&#233;m os resultados&#44; justificada principalmente pela aus&#234;ncia de participa&#231;&#227;o de militares do g&#233;nero feminino neste curso de for&#231;as especiais&#46; Outra limita&#231;&#227;o prende&#8208;se com a incapacidade de quantificar objetivamente o exerc&#237;cio f&#237;sico n&#227;o programado praticado pelos militares durante o curso&#46; Estes indiv&#237;duos est&#227;o permanentemente envolvidos em atividades e avalia&#231;&#245;es&#44; nas quais a componente f&#237;sica &#233; fulcral&#44; mesmo n&#227;o praticando exerc&#237;cio f&#237;sico convencional ou programado&#46; Por fim&#44; apesar de todos os participantes negarem veementemente a toma de subst&#226;ncias estimulantes&#44; no protocolo do estudo&#44; tal n&#227;o foi comprovado&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclus&#227;o</span><p id="par0250" class="elsevierStylePara elsevierViewall">Neste estudo&#44; verificou&#8208;se uma remodelagem antropom&#233;trica e cardiovascular tanto nos militares de for&#231;as especiais como em basquetebolistas de n&#237;vel competitivo&#44; ap&#243;s o curso militar ou &#233;poca desportiva&#46; Essa remodelagem apresentou carater&#237;sticas distintas&#44; nos militares de predom&#237;nio exc&#234;ntrico e nos basquetebolistas conc&#234;ntrico&#46; As novas modalidades ecocardiogr&#225;ficas&#44; nomeadamente a an&#225;lise da deforma&#231;&#227;o mioc&#225;rdica&#44; podem revelar um padr&#227;o tamb&#233;m compat&#237;vel com adapta&#231;&#227;o fisiol&#243;gica ao exerc&#237;cio f&#237;sico&#44; podendo contribuir para a diferencia&#231;&#227;o entre &#171;cora&#231;&#227;o de atleta&#187; e patologia card&#237;aca&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Responsabilidades &#233;ticas</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Prote&#231;&#227;o de pessoas e animais</span><p id="par0255" 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="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Confidencialidade dos dados</span><p id="par0260" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Direito &#224; privacidade e consentimento escrito</span><p id="par0265" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflito de interesses</span><p id="par0270" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico &#233; frequente em atletas&#46; Esta adapta&#231;&#227;o manifesta&#8208;se a n&#237;vel estrutural com o aumento das dimens&#245;es e massa card&#237;acas&#46; Os militares tamb&#233;m s&#227;o sujeitos a exerc&#237;cio f&#237;sico intenso&#44; com especificidades distintas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar a remodelagem card&#237;aca induzida pelo exerc&#237;cio f&#237;sico em atletas de competi&#231;&#227;o e pelo treino militar em militares a frequentar um curso de for&#231;as especiais&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Metodologia</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estud&#225;mos 17 militares &#40;g&#233;nero masculino e caucasianos&#44; idade m&#233;dia 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 anos&#41; que ingressaram no curso de Comandos e 17 basquetebolistas &#40;47&#44;3&#37; do g&#233;nero masculino&#44; 64&#44;7&#37; caucasianos&#44; idade m&#233;dia 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 anos&#41;&#46; A avalia&#231;&#227;o incluiu um ecocardiograma transtor&#225;cico com an&#225;lise da mec&#226;nica mioc&#225;rdica&#46; Esta avalia&#231;&#227;o foi realizada no in&#237;cio e no final do curso militar e da &#233;poca desportiva&#44; respetivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca teve caracter&#237;sticas distintas&#58; os militares apresentaram um padr&#227;o predominantemente exc&#234;ntrico&#44; com aumento das dimens&#245;es do ventr&#237;culo esquerdo &#40;49&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2 <span class="elsevierStyleItalic">versus</span> 52&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e da massa &#40;93&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;7 <span class="elsevierStyleItalic">versus</span> 100&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4<span class="elsevierStyleHsp" style=""></span>g&#47;m<span class="elsevierStyleSup">2</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e diminui&#231;&#227;o da espessura relativa das paredes &#40;0&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#59; os basquetebolistas apresentaram um padr&#227;o conc&#234;ntrico&#44; com diminui&#231;&#227;o das dimens&#245;es do ventr&#237;culo esquerdo &#40;52&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 <span class="elsevierStyleItalic">versus</span> 50&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e da espessura relativa das paredes &#40;0&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1 <span class="elsevierStyleItalic">versus</span> 0&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Apesar da deforma&#231;&#227;o mioc&#225;rdica global do ventr&#237;culo esquerdo n&#227;o apresentar diferen&#231;as significativas entre os grupos&#44; quando analisados em conjunto o seu valor diminuiu &#40;&#8208;20&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&#37; <span class="elsevierStyleItalic">versus</span> &#8208;19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A remodelagem card&#237;aca foi frequente&#44; com padr&#227;o exc&#234;ntrico nos militares e conc&#234;ntrico nos atletas&#46; A mec&#226;nica mioc&#225;rdica poder&#225; representar uma adapta&#231;&#227;o fisiol&#243;gica induzida pelo exerc&#237;cio f&#237;sico&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Exercise&#8208;induced cardiac remodeling is frequent in athletes&#46; This adaptation is structurally manifested by an increase in cardiac dimensions and mass&#46; Soldiers are also subject to intense physical exercise&#44; although with different characteristics&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">To compare exercise&#8208;induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">We studied 17 soldiers &#40;all male and Caucasian&#44; mean age 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41; who completed a special forces course and 17 basketball players &#40;47&#46;3&#37; male&#44; 64&#46;7&#37; Caucasian&#44; mean age 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41;&#46; Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics&#46; This assessment was performed at the beginning and end of the military course and the sports season&#44; respectively&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Cardiac remodeling was observed in both groups&#46; The soldiers presented a predominantly eccentric pattern&#44; with increased left ventricular &#40;LV&#41; size &#40;49&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2 vs&#46; 52&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; increased LV mass &#40;93&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;7 vs&#46; 100&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;4 g&#47;m2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and decreased relative wall thickness &#40;0&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1 vs&#46; 0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The basketball players showed a concentric pattern&#44; with decreased LV size &#40;52&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7 vs&#46; 50&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7 mm&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and increased relative wall thickness &#40;0&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1 vs&#46; 0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Although there was no significant difference in LV myocardial strain in the groups separately&#44; when compared there was a significant decrease &#40;&#8208;20&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&#37; vs&#46; &#8208;19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Cardiac remodeling was frequent&#44; with an eccentric pattern in soldiers and a concentric pattern in basketball players&#46; Myocardial deformation may represent a physiological adaptation to physical exercise&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\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">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \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">PAD &#40;mm Hg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
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                  \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">FC &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        ]
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col"><br>Par&#226;metros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\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">Final&nbsp;\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 valor&nbsp;\t\t\t\t\t\t\n
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ISSN: 08702551
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2023 Junho 67 15 82
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2023 Abril 56 6 62
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2023 Janeiro 76 29 105
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2022 Novembro 101 36 137
2022 Outubro 79 30 109
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2022 Agosto 55 40 95
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2022 Maio 45 29 74
2022 Abril 44 41 85
2022 Maro 59 41 100
2022 Fevereiro 48 36 84
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2021 Novembro 46 33 79
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2021 Setembro 36 30 66
2021 Agosto 43 40 83
2021 Julho 29 29 58
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2021 Maio 53 45 98
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2020 Novembro 68 43 111
2020 Outubro 67 27 94
2020 Setembro 46 17 63
2020 Agosto 29 27 56
2020 Julho 43 23 66
2020 Junho 55 27 82
2020 Maio 62 25 87
2020 Abril 50 31 81
2020 Maro 71 34 105
2020 Fevereiro 147 63 210
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2019 Dezembro 51 13 64
2019 Novembro 134 20 154
2019 Outubro 54 11 65
2019 Setembro 82 40 122
2019 Agosto 32 18 50
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2019 Junho 24 26 50
2019 Maio 31 22 53
2019 Abril 23 21 44
2019 Maro 58 27 85
2019 Fevereiro 40 12 52
2019 Janeiro 30 11 41
2018 Dezembro 48 16 64
2018 Novembro 117 16 133
2018 Outubro 238 14 252
2018 Setembro 71 9 80
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