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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0010" class="elsevierStylePara elsevierViewall">S&#237;ncope define&#8208;se como uma perda transit&#243;ria de consci&#234;ncia e do t&#243;nus postural rapidamente revers&#237;vel secund&#225;ria a um per&#237;odo de hipoperfus&#227;o cerebral<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#46; &#201; um sintoma que tem um leque extenso de poss&#237;veis causas&#44; desde benignas a potencialmente fatais<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#46; As causas de s&#237;ncope podem ser genericamente divididas em causas card&#237;acas ou n&#227;o card&#237;acas&#46; Os doentes com etiologia card&#237;aca t&#234;m geralmente maiores taxas de mortalidade&#44; independentemente da idade<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#46; &#201; respons&#225;vel por cerca de 1&#8208;5&#37; das admiss&#245;es no servi&#231;o de urg&#234;ncia<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#46; No entanto&#44; apenas 1&#8208;6&#37; dos doentes com s&#237;ncope recorrem ao servi&#231;o urg&#234;ncia hospitalar<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o inicial do doente com s&#237;ncope tem&#44; assim&#44; dois objetivos fundamentais&#58; excluir uma poss&#237;vel etiologia card&#237;aca e determinar o risco de futuros eventos adversos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&#46; Numa abordagem diagn&#243;stica destes doentes s&#227;o cruciais uma avalia&#231;&#227;o exaustiva com colheita de hist&#243;ria cl&#237;nica com boa caracteriza&#231;&#227;o dos epis&#243;dios de s&#237;ncope e a integra&#231;&#227;o dos achados do exame objetivo e eletrocardiograma de 12 deriva&#231;&#245;es &#233; crucial para a abordagem diagn&#243;stica destes doentes<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Ainda assim&#44; v&#225;rios estudos demonstraram que a avalia&#231;&#227;o inicial apenas determina um diagn&#243;stico final em 20&#8208;50&#37; dos casos<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;10&#44;11</span></a>&#46; Nesse contexto&#44; v&#225;rios <span class="elsevierStyleItalic">scores</span> de risco t&#234;m sido desenvolvidos e validados para a triagem inicial do doente com s&#237;ncope&#44; por forma a selecionar os doentes com maior risco de etiologia card&#237;aca e de eventos adversos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;12&#8211;15</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">Evaluation of Guidelines in Syncope Study</span> &#40;EGSYS&#41; &#233; um <span class="elsevierStyleItalic">score</span> com vari&#225;veis cl&#237;nicas e eletrocardiogr&#225;ficas&#44; desenvolvido para a triagem dos doentes que se apresentam com s&#237;ncope no servi&#231;o de urg&#234;ncia&#44; avalia a probabilidade de se tratar de etiologia card&#237;aca&#46; Tem em conta 6 vari&#225;veis&#58; a&#41; presen&#231;a de doen&#231;a card&#237;aca ou ECG de 12 deriva&#231;&#245;es anormal &#40;&#43;3 pontos&#41;&#59; b&#41; palpita&#231;&#245;es antes da s&#237;ncope &#40;&#43;4 pontos&#41;&#59; c&#41; s&#237;ncope precipitada por esfor&#231;o &#40;&#43;3 pontos&#41;&#59; d&#41; s&#237;ncope em posi&#231;&#227;o deitada &#40;&#43;2 pontos&#41;&#59; e&#41; pr&#243;dromos vegetativos &#40;&#8208;1 ponto&#41;&#59; f&#41; exist&#234;ncia de fatores precipitantes &#40;&#8208;1 ponto&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&#46; Foi criado e validado para utiliza&#231;&#227;o no contexto de urg&#234;ncia por forma a determinar que doentes correm maior risco de eventos adversos e podem beneficiar de hospitaliza&#231;&#227;o e investiga&#231;&#227;o etiol&#243;gica mais exaustiva&#46; Para um limiar &#61;3 tem uma sensibilidade e especificidade para diagn&#243;stico de s&#237;ncope card&#237;aca de 92&#37; e 69&#37;&#44; respetivamente&#44; e demonstra uma forte associa&#231;&#227;o progn&#243;stica&#44; determina baixa mortalidade nos doentes com EGSYS &#60; 3<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;16&#44;17</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">No entanto&#44; a sua validade em contexto de ambulat&#243;rio n&#227;o foi testada&#44; pelo que a sua aplicabilidade nestas situa&#231;&#245;es se mant&#233;m incerta&#46; Assim&#44; o presente trabalho pretende avaliar a sua acuidade diagn&#243;stica em contexto de consulta externa num centro com unidade de s&#237;ncope para onde s&#227;o referenciados os doentes com s&#237;ncope de etiologia incerta&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo retrospetivo&#44; descritivo e correlacional da consulta externa de s&#237;ncope dum centro hospitalar com doentes avaliados em primeira consulta de 1 de janeiro de 2015 a 31 de dezembro de 2016&#46; Foram identificados os doentes que efetivamente tiveram s&#237;ncope e qual a sua etiologia&#46; Nos doentes com s&#237;ncope&#44; o <span class="elsevierStyleItalic">score</span> EGSYS foi calculado para cada doente e foi avaliada a capacidade de predi&#231;&#227;o da etiologia card&#237;aca&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos todos os doentes avaliados numa primeira consulta no per&#237;odo do estudo&#46; Nas consultas foi feito um registo eletr&#243;nico com descri&#231;&#227;o de caracter&#237;sticas basais do doente&#44; antecedentes pessoais&#44; caracter&#237;sticas dos epis&#243;dios de perda de consci&#234;ncia&#44; pr&#243;dromos&#44; fatores predisponentes&#44; sintomas da recupera&#231;&#227;o&#44; exame objetivo e descri&#231;&#227;o do ECG de 12 deriva&#231;&#245;es&#46; A ocorr&#234;ncia de s&#237;ncope foi definida de acordo com as recomenda&#231;&#245;es da Sociedade Europeia de Cardiologia&#46; Considerou&#8208;se exist&#234;ncia de doen&#231;a card&#237;aca quando na presen&#231;a de um dos seguintes&#58; hist&#243;ria pr&#233;via ou diagnostico cl&#237;nico de qualquer forma de doen&#231;a card&#237;aca estrutural&#44; incluindo cardiopatia isqu&#233;mica&#44; disfun&#231;&#227;o valvular&#44; miocardiopatias ou cardiopatia cong&#233;nita&#59; diagn&#243;stico pr&#233;vio ou evid&#234;ncia cl&#237;nica de insufici&#234;ncia card&#237;aca congestiva&#59; sinais f&#237;sicos de doen&#231;a card&#237;aca estrutural&#46; O ECG foi considerado anormal na presen&#231;a de&#58; bradicardia sinusal &#60; 40&#47;min&#59; bloqueio auriculoventricular superior a primeiro grau&#59; bloqueio completo de ramo&#59; presen&#231;a de ondas Q patol&#243;gicas&#59; taquicardia supraventricular ou ventricular&#59; hipertrofia ventricular esquerda ou direita&#59; pr&#233;&#8208;excita&#231;&#227;o ventricular&#59; intervalo QT longo&#59; padr&#227;o de Brugada&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os doentes foram avaliados de acordo com um protocolo previamente publicado<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&#46; Adicionalmente&#44; foi realizada prova de esfor&#231;o nos doentes com sintomas em contexto de esfor&#231;o e monitora&#231;&#227;o ambulat&#243;ria de press&#227;o arterial em casos de suspeita de hipotens&#227;o iatrog&#233;nica&#46; Os doentes com suspeita de patologia neurol&#243;gica foram referenciados para consulta de neurologia&#44; onde foram adicionalmente avaliados com outros m&#233;todos complementares de diagn&#243;stico&#44; ao crit&#233;rio do neurologista &#40;EEG&#44; resson&#226;ncia magn&#233;tica cr&#226;nio&#8208;encef&#225;lica&#44; tomografia computorizada cr&#226;nio&#8208;encef&#225;lica&#41;&#46; S&#237;ncope card&#237;aca por causa mec&#226;nica foi diagnosticada na presen&#231;a de estenose valvular severa ou outra forma de obstru&#231;&#227;o de fluxo&#46; S&#237;ncope arr&#237;tmica foi diagnosticada na presen&#231;a de&#58; documenta&#231;&#227;o de s&#237;ncope ou sintomas prodr&#243;micos coincidentes com registo eletrocardiogr&#225;fico de per&#237;odo de bradicardia sinusal &#60; 40&#47;min ou com pausa sinusal &#62; 3 segundos&#44; per&#237;odo de bloqueio aur&#237;culo ventricular de segundo grau Mobitz I ou per&#237;odo de taquicardia supraventricular&#59; documenta&#231;&#227;o eletrocardiogr&#225;fica de per&#237;odo de bloqueio auriculoventricular de 2&#46;&#176; grau Mobitz II ou 3&#46;&#176; grau&#44; bloqueio alternante de ramo&#44; disfun&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> com pausa ou per&#237;odos de taquicardia ventricular parox&#237;sticas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para an&#225;lise estat&#237;stica foi efetuada an&#225;lise descritiva para a caracteriza&#231;&#227;o do perfil da popula&#231;&#227;o&#46; As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dia e desvio&#8208;padr&#227;o&#46; As vari&#225;veis categ&#243;ricas s&#227;o apresentadas em n&#250;mero &#40;percentagem&#41;&#46; Para averiguar exist&#234;ncia de associa&#231;&#227;o entre cada uma das vari&#225;veis e etiologia card&#237;aca de s&#237;ncope foi utilizado o teste qui&#8208;quadrado&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Foi calculado o <span class="elsevierStyleItalic">score</span> EGSYS para cada doente e dividiu&#8208;se a popula&#231;&#227;o em 2 grupos&#58; os doentes com EGSYS &#60; 3 e os doentes com EGSYS &#61; 3&#46; Foi determinada a exist&#234;ncia de associa&#231;&#227;o estat&#237;stica entre cada vari&#225;vel e entre a etiologia da s&#237;ncope entre cada grupo utilizando o teste qui&#8208;quadrado para as vari&#225;veis categ&#243;ricas e o teste <span class="elsevierStyleItalic">t</span> de Student para as vari&#225;veis cont&#237;nuas&#46; Foram determinados a sensibilidade&#44; especificidade e valor preditivo positivo e negativo do score para a popula&#231;&#227;o em causa&#46; A capacidade preditiva foi testada por an&#225;lise da &#225;rea abaixo da curva &#40;AUC&#41; <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Foi realizado <span class="elsevierStyleItalic">follow&#8208;up</span> aos dois anos por via telef&#243;nica por cardiologista para determina&#231;&#227;o de mortalidade&#46; A mortalidade foi comparada entre ambos os grupos e avaliada a sobreviv&#234;ncia atrav&#233;s de modelos de Kaplan&#8208;Meier&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Considerou&#8208;se como n&#237;vel de signific&#226;ncia o valor de 95&#37; com um valor p inferior a 0&#44;05&#46; A an&#225;lise estat&#237;stica foi feita com o <span class="elsevierStyleItalic">software</span> IBM SPSS Statistics &#40;vers&#227;o 24&#46;0&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Foram avaliados 248 doentes em primeira consulta ao longo do per&#237;odo do estudo&#46; Foram exclu&#237;dos 24 &#40;9&#44;7&#37;&#41; doentes por aus&#234;ncia de dados suficientes para c&#225;lculo do <span class="elsevierStyleItalic">score</span>&#46; Dos 224 doentes inclu&#237;dos&#44; 116 &#40;51&#44;8&#37;&#41; eram do sexo masculino&#44; com m&#233;dia de 64&#44;7 &#177; 21&#44;4 anos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46; Como fatores de risco cardiovascular&#44; 140 &#40;62&#44;5&#37;&#41; eram hipertensos&#44; 101 &#40;45&#44;1&#37;&#41; tinham dislipidemia&#44; 42 &#40;18&#44;8&#37;&#41; tinham diabetes <span class="elsevierStyleItalic">mellitus</span> e 17 &#40;7&#44;6&#37;&#41; eram fumadores ativos&#46; Tinham cardiopatia estrutural 36 &#40;18&#44;1&#37;&#41; e 56 &#40;25&#44;0&#37;&#41; tinham altera&#231;&#245;es eletrocardiogr&#225;ficas&#46; Em 125 &#40;55&#44;8&#37;&#41; os doentes referiram mais do que um epis&#243;dio de s&#237;ncope&#44; em 36 &#40;16&#44;1&#37;&#41; referiram epis&#243;dios de pr&#233;&#8208;sincope sem perda de consci&#234;ncia&#44; em 46 &#40;20&#44;5&#37;&#41; referiram s&#237;ncope sem pr&#243;dromos e em 45 &#40;20&#44;1&#37;&#41; alguma forma de trauma&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A referencia&#231;&#227;o para a consulta de s&#237;ncope foi predominantemente feita a partir do Servi&#231;o de Urg&#234;ncia em 39&#44;3&#37; dos casos&#44; dos cuidados de sa&#250;de prim&#225;rios em 27&#44;2&#37; e da consulta externa de outra especialidade em 20&#44;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Relativamente &#224; caracteriza&#231;&#227;o da utiliza&#231;&#227;o de m&#233;todos complementares de diagn&#243;stico&#44; 123 &#40;54&#44;9&#37;&#41; doentes realizaram Holter 24<span class="elsevierStyleHsp" style=""></span>h&#44; 122 &#40;54&#44;5&#37;&#41; ecocardiograma transtor&#225;cico&#44; 61 &#40;27&#44;2&#37;&#41; teste Tilt&#44; 27 &#40;12&#44;1&#37;&#41; prova de esfor&#231;o&#44; 25 &#40;11&#44;2&#37;&#41; detetor de eventos externo&#44; 23 &#40;10&#44;3&#37;&#41; massagem do seio carot&#237;deo&#44; 20 &#40;8&#44;9&#37;&#41; monitora&#231;&#227;o ambulat&#243;ria da press&#227;o arterial&#44; 12 &#40;5&#44;4&#37;&#41; registador de eventos implant&#225;vel e 3 &#40;1&#44;3&#37;&#41; realizaram estudo eletrofisiol&#243;gico &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Constatou&#8208;se que dos 248 doentes&#44; 163 &#40;72&#44;8&#37;&#41; tiveram efetivamente s&#237;ncope&#44; de etiologia card&#237;aca em 27 &#40;12&#44;1&#37;&#41; e de etiologia n&#227;o card&#237;aca em 136 &#40;60&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; Dos restantes doentes&#44; 17 &#40;7&#44;9&#37;&#41; tiveram perda de consci&#234;ncia de etiologia neurol&#243;gica&#44; 4 &#40;4&#44;9&#37;&#41; de etiologia psicog&#233;nica&#44; 11 &#40;4&#44;9&#37;&#41; continuam em estudo com registador de eventos implant&#225;vel e em 29 &#40;12&#44;9&#37;&#41; casos constatou&#8208;se que n&#227;o houve efetivamente perda de consci&#234;ncia&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Foi calculado o <span class="elsevierStyleItalic">score</span> EGSYS para os 163 &#40;72&#44;8&#37;&#41; doentes que tiveram efetivamente s&#237;ncope&#46; O n&#250;mero total de doentes com EGSYS &#60; 3 foi 120 &#40;73&#44;6&#37;&#41; e 43 &#40;19&#44;2&#37;&#41; tiveram EGSYS &#61; 3&#46; Entre os doentes com <span class="elsevierStyleItalic">score</span> &#60; 3&#44; o score m&#233;dio foi de &#8208;0&#44;2 &#177; 1&#44;1 <span class="elsevierStyleItalic">versus</span> 3&#44;7 &#177; 1&#44;3 no grupo com EGSYS &#61; 3 &#40;p&#8208;valor &#60; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> foi significativamente superior nos doentes com s&#237;ncope de etiologia card&#237;aca &#40;1&#44;85 &#177; 2&#44;3 <span class="elsevierStyleItalic">versus</span> 0&#44;64 &#177; 2&#44;0&#44; p&#8208;valor 0&#44;005&#41; e foi mais frequentemente positivo nestes doentes &#40;30&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 11&#44;7&#37;&#44; p&#8208;valor 0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; Entre causas individuais de s&#237;ncope card&#237;aca e s&#237;ncope n&#227;o card&#237;aca n&#227;o se verificou diferen&#231;a entre ambos os grupos&#46; N&#227;o se verificaram diferen&#231;as na mortalidade entre ambos os grupos &#40;9&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 9&#44;5&#37;&#44; p&#8208;valor 0&#44;945&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Relativamente aos par&#226;metros individuais do <span class="elsevierStyleItalic">score</span> de EGSYS&#44; verificou&#8208;se que a presen&#231;a de altera&#231;&#245;es eletrocardiogr&#225;ficas ou doen&#231;a card&#237;aca foi significativamente mais frequente nos doentes com s&#237;ncope de etiologia card&#237;aca &#40;44&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 25&#44;7&#37;&#44; p&#8208;valor 0&#44;05&#41;&#44; enquanto os fatores precipitantes eram significativamente menos frequentes &#40;14&#44;8&#37; <span class="elsevierStyleItalic">versus</span> 42&#44;6&#37;&#44; p&#8208;valor 0&#44;007&#41;&#46; Relativamente aos outros par&#226;metros&#44; n&#227;o se verificou diferen&#231;a entre etiologias &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A sensibilidade do <span class="elsevierStyleItalic">score</span> EGSYS &#61; 3 para prever etiologia card&#237;aca foi de 48&#44;2&#37; &#40;IC 95&#37;&#58; 28&#44;7&#37;&#8208;68&#44;1&#37;&#41;&#44; a especificidade de 77&#44;9&#37; &#40;IC 95&#37;&#58; 70&#44;0&#37;&#8208;84&#44;6&#37;&#41;&#44; valor preditivo positivo de 30&#44;23&#37; &#40;IC 95&#37;&#58; 20&#44;8&#37;&#8208;41&#44;8&#37;&#41;&#44; valor preditivo negativo de 88&#44;3&#37; &#40;IC 95&#37;&#58; 83&#44;9&#37;&#8208;91&#44;7&#37;&#41; e acuidade diagn&#243;stica de 73&#44;0&#37; &#40;IC 95&#37;&#58; 65&#44;5&#37;&#8208;79&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46; A capacidade preditiva do <span class="elsevierStyleItalic">score</span> EGSYS na nossa popula&#231;&#227;o foi baixa&#44; com uma &#225;rea abaixo da curva de ROC de 0&#44;66 &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">A nossa unidade de s&#237;ncope &#233; uma unidade de ambulat&#243;rio integrada na consulta externa do hospital&#44; para onde s&#227;o enviados doentes com s&#237;ncope de etiologia incerta ap&#243;s investiga&#231;&#227;o inicial pelo m&#233;dico referenciador&#46; A referencia&#231;&#227;o na maioria dos casos prov&#233;m do Servi&#231;o de Urg&#234;ncia e da Medicina Geral e Familiar&#46; Assim&#44; doentes com s&#237;ncope de origem card&#237;aca j&#225; identificados e referenciados para tratamento n&#227;o s&#227;o observados nesta consulta&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Os doentes deste estudo foram sequencialmente observados por cardiologista&#44; foi colhida uma anamnese exaustiva&#44; realizado exame objetivo e realizado ECG de 12 deriva&#231;&#245;es&#46; O processo de avalia&#231;&#227;o subsequente seguiu os algoritmos apresentados por Pedro Sousa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> No nosso estudo&#44; os exames complementares de diagn&#243;stico mais frequentemente requisitados foram o Holter de 24<span class="elsevierStyleHsp" style=""></span>h&#44; o ecocardiograma transtor&#225;cico&#44; o teste de Tilt e o detetor de eventos externo&#46; Nas situa&#231;&#245;es com suspeita de perda de consci&#234;ncia de etiologia neurol&#243;gica&#44; foi solicitada observa&#231;&#227;o por neurologista&#44; com requisi&#231;&#227;o subsequente dos exames complementares de diagn&#243;stico considerados adequados&#46; Com esta abordagem&#44; no per&#237;odo do estudo tivemos um diagn&#243;stico final em 95&#37; doentes&#46; O diagn&#243;stico de s&#237;ncope de etiologia card&#237;aca foi feito em 12&#44;9&#37; dos casos&#44; o que est&#225; de acordo com as taxas encontradas noutros trabalhos<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2&#44;18&#8211;22</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">O valor das caracter&#237;sticas da s&#237;ncope na colheita da hist&#243;ria cl&#237;nica&#44; do exame objetivo e do ECG de 12 deriva&#231;&#245;es na predi&#231;&#227;o da etiologia da s&#237;ncope e de eventos adversos j&#225; t&#234;m sido avaliado em diferentes estudos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;17&#44;23</span></a>&#46; V&#225;rios <span class="elsevierStyleItalic">scores</span> j&#225; t&#234;m sido criados e propostos com esta finalidade&#46; A cria&#231;&#227;o do score EGSYS partiu da necessidade de triar doentes no contexto do servi&#231;o de urg&#234;ncia num doente com s&#237;ncope recente&#44; por forma a distinguir doentes com alta probabilidade de etiologia card&#237;aca&#44; reduzir assim o n&#250;mero de hospitaliza&#231;&#245;es desnecess&#225;rias<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&#46; O <span class="elsevierStyleItalic">follow&#8208;up</span> a um m&#234;s e a dois anos demonstrou uma mortalidade aumentada em doentes com <span class="elsevierStyleItalic">scores</span> mais elevados<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> e o <span class="elsevierStyleItalic">score</span> parece ter uma sensibilidade para prever mortalidade e eventos desfavor&#225;veis de 80&#37; e 56&#37;&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">No entanto&#44; a sua validade no contexto de doentes avaliados em contexto de consulta externa com descri&#231;&#227;o de epis&#243;dios de s&#237;ncope pr&#233;via n&#227;o investigados n&#227;o foi estabelecida&#46; Com base neste estudo&#44; um valor do <span class="elsevierStyleItalic">score</span> EGSYS &#61; 3 tem baixa sensibilidade para prever etiologia da s&#237;ncope no contexto de consulta externa&#44; apresenta no entanto uma especificidade aceit&#225;vel&#46; O EGSYS m&#233;dio nos doentes com s&#237;ncope card&#237;aca foi significativamente mais alto &#40;quase o tr&#234;s vezes superior&#41; do que nos doentes com etiologia n&#227;o card&#237;aca&#46; Destaca&#8208;se um valor preditivo negativo para s&#237;ncope card&#237;aca significativo&#44; o que pode revelar a sua utilidade como um indicador de baixa probabilidade de etiologia card&#237;aca e indicar casos com que possam beneficiar de um <span class="elsevierStyleItalic">follow&#8208;up</span> mais espa&#231;ado temporalmente e menos exames complementares de diagn&#243;stico&#46; A &#225;rea abaixo da curva foi de 0&#44;66&#44; o que lhe confere uma baixa capacidade preditiva de s&#237;ncope card&#237;aca&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Entre os par&#226;metros do <span class="elsevierStyleItalic">score</span>&#44; a exist&#234;ncia de doen&#231;a card&#237;aca tem sido apontada como a mais sens&#237;vel para etiologia card&#237;aca<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">22&#44;25</span></a>&#44; apesar de uma percentagem significativa de doentes com patologia card&#237;aca ter s&#237;ncope neuromediada<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&#46; Na nossa amostra&#44; os par&#226;metros que tiveram maior associa&#231;&#227;o com o diagn&#243;stico final foram a exist&#234;ncia de altera&#231;&#245;es eletrocardiogr&#225;ficas ou doen&#231;a card&#237;aca pr&#233;via e a presen&#231;a de fatores precipitantes para a s&#237;ncope&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A mortalidade de 9&#44;2&#37; a 2 anos &#233; equivalente &#224; da popula&#231;&#227;o geral de outros trabalhos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;17</span></a>&#46; No entanto&#44; ao contr&#225;rio desses mesmos trabalhos&#44; o <span class="elsevierStyleItalic">score</span> EGSYS perde a capacidade de discriminar na nossa popula&#231;&#227;o os doentes com maior risco de eventos&#46; Tal pode ser justificado pelas diferen&#231;as inerentes &#224; nossa popula&#231;&#227;o&#44; que &#233; avaliada em contexto de ambulat&#243;rio e exclui doentes diagnosticados no servi&#231;o de urg&#234;ncia e nos cuidados de sa&#250;de prim&#225;rios&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Este trabalho apresenta algumas limita&#231;&#245;es&#46; Trata&#8208;se de um estudo retrospetivo&#44; com uma amostra pequena&#46; Baseia&#8208;se nos registos eletr&#243;nicos realizados durante a consulta&#44; pode estar sujeito a erros de codifica&#231;&#227;o&#46; Trata&#8208;se de uma popula&#231;&#227;o selecionada&#44; constitu&#237;da apenas por doentes que foram referenciados &#224; nossa consulta por a s&#237;ncope permanecer de etiologia incerta ap&#243;s avalia&#231;&#227;o m&#233;dica pr&#233;via&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclus&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">O EGSYS &#233; um <span class="elsevierStyleItalic">score</span> simples de calcular&#44; baseado em dados da anamnese&#44; exame objetivo e ECG que tem um bom valor preditivo negativo para s&#237;ncope de etiologia card&#237;aca no contexto de consulta externa&#44; pode ter utilidade na sele&#231;&#227;o de doentes que n&#227;o necessitem de uma investiga&#231;&#227;o t&#227;o exaustiva&#46; Outras informa&#231;&#245;es associadas parecem ter utilidade limitada neste contexto&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0145" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#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">O <span class="elsevierStyleItalic">score</span> EGSYS para avalia&#231;&#227;o do doente com s&#237;ncope em contexto de urg&#234;ncia utiliza vari&#225;veis de ordem cl&#237;nica e foi validado para diferenciar entre s&#237;ncope de etiologia card&#237;aca &#40;SC&#41; ou n&#227;o card&#237;aca &#40;SNC&#41;&#46; Este trabalho pretende determinar se o <span class="elsevierStyleItalic">score</span> tem a mesma aplicabilidade no contexto de consulta&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo a partir dos registos eletr&#243;nicos dos doentes observados em consulta externa de s&#237;ncope entre janeiro de 2015 e dezembro de 2016&#46; Foi calculado o <span class="elsevierStyleItalic">score</span> EGSYS para cada doente e determinada a sensibilidade e especificidade para a predi&#231;&#227;o de etiologia card&#237;aca em doentes com score 3&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados 224 doentes&#44; com m&#233;dia de 64&#44;3 &#177; 21&#44;7 anos&#44; 116 &#40;51&#44;8&#37;&#41; eram do sexo masculino&#46; Nos 163 &#40;72&#44;7&#37;&#41; com s&#237;ncope confirmada&#44; o diagn&#243;stico foi de SC em 27 &#40;16&#44;6&#37;&#41; e SNC em 136 &#40;83&#44;4&#37;&#41;&#46; O <span class="elsevierStyleItalic">score</span> EGSYS foi 3 em 40 &#40;20&#44;0&#37;&#41; doentes com SNC e em 13 &#40;48&#44;1&#37;&#41; com SC&#46; Um <span class="elsevierStyleItalic">score</span> 3 teve uma sensibilidade de 48&#44;2&#37; &#40;IC 95&#37;&#58; 28&#44;7&#8208;68&#44;1&#41;&#44; uma especificidade de 77&#44;9&#37; &#40;CI 95&#37;&#58; 70&#44;0&#8208;84&#44;6&#41;&#44; um valor preditivo positivo e negativo de 30&#44;2&#37; &#40;CI 95&#37;&#58; 20&#44;8 &#8211; 41&#44;8&#41; e 88&#44;3&#37; &#40;CI 95&#58; 83&#44;9 &#8211; 91&#44;7&#41; respetivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> EGSYS tem utilidade limitada no contexto de consulta de s&#237;ncope&#44; que recebe doentes filtrados por avalia&#231;&#227;o m&#233;dica pr&#233;via&#46; Dada a sua elevada especificidade e valor preditivo negativo&#44; poder&#225; ter utilidade como tranquilizador do doente e parentes no contexto cl&#237;nico apropriado&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The EGSYS score uses clinical variables to predict which patients may have cardiac &#40;CS&#41; or non&#8208;cardiac syncope &#40;NCS&#41; and has been validated in the emergency department setting&#46; This study aims to determine whether the score has the same applicability in an outpatient setting&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">In this retrospective study of all patients observed in the outpatient setting of a hospital with a syncope unit between January 2015 and December 2016&#44; the EGSYS score was calculated for each patient&#44; and its sensitivity and specificity were determined for the prediction of CS in patients with score &#8805;3&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">A total of 224 patients&#44; mean age 64&#46;3&#177;21&#46;7 years&#44; 116 &#40;51&#46;8&#37;&#41; male&#44; were analyzed&#46; In the 163 &#40;72&#46;7&#37;&#41; patients with confirmed syncope&#44; CS was diagnosed in 27 &#40;16&#46;6&#37;&#41; and NCS in 136 &#40;83&#46;4&#37;&#41;&#46; The EGSYS score was &#8805;3 in 40 &#40;20&#46;0&#37;&#41; patients with NCS and in 13 &#40;48&#46;1&#37;&#41; with CS&#46; A positive score had a sensitivity of 48&#46;2&#37; &#40;95&#37; CI&#58; 28&#46;7&#8208;68&#46;1&#41;&#44; a specificity of 77&#46;9&#37; &#40;95&#37; CI&#58; 70&#46;0&#8208;84&#46;6&#41;&#44; and a positive and negative predictive value of 30&#46;2&#37; &#40;95&#37; CI&#58; 20&#46;8&#8208;41&#46;8&#41; and 88&#46;3&#37; &#40;95&#37; CI&#58; 83&#46;9&#8208;91&#46;7&#41;&#44; respectively&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The EGSYS score has limited usefulness in an outpatient setting&#44; where observed patients have already been been medically assessed&#46; Given its high specificity and negative predictive value&#44; it may be useful to reassure low&#8208;risk patients and family members&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de doentes n &#61; 224&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Idade &#40;anos&#41;&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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 &#40;62&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;45&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;7&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a estrutural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Altera&#231;&#245;es eletrocardiogr&#225;ficas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;25&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sincope recorrente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125 &#40;55&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epis&#243;dios de pr&#233;&#8208;sincope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sincope sem pr&#243;dromos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;20&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;20&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2327595.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas da popula&#231;&#227;o avaliada em consulta</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EGSYS &#60; 3 &#40;n &#61; 120&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EGSYS &#8805; 3 &#40;n &#61; 43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EGSYS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;0&#44;2 &#177; 1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Altera&#231;&#245;es ECG ou doen&#231;a card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;15&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;65&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Palpita&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;34&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante o esfor&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;11&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deitado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pr&#243;dromos vegetativos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;14&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatores precipitantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiologia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;30&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taquidisritmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;7&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bradidisritmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;8&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;18&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estrutural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;88&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;69&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reflexa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;35&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;37&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Situacional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;18&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipotens&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;20&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;14&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipotens&#227;o ortost&#225;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;10&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disautonomia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#211;bito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2327594.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos doentes com <span class="elsevierStyleItalic">score</span> positivo <span class="elsevierStyleItalic">versus</span> negativo</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Elementos individuais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sincope card&#237;aca n &#61; 27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;ncope n&#227;o card&#237;aca n &#61; 136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EGSYS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;85 &#177; 2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64 &#177; 2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Altera&#231;&#245;es ECG ou doen&#231;a card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;27&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Palpita&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante o esfor&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deitado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pr&#243;dromos vegetativos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Fatores precipitantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;14&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;42&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;007&nbsp;\t\t\t\t\t\t\n
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                          "colaboracion" => "ESC Scientific Document Group"
                          "etal" => true
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