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aumento de &#225;cidos graxos livres circulantes e de triacilglicer&#243;is&#44; estejam envolvidos na sua etiopatogenia&#46; Com o avan&#231;o tecnol&#243;gico&#44; diversos m&#233;todos diagn&#243;sticos&#44; em especial os de imagem&#44; tem sido utilizados para elucidar essa entidade tanto na DM1 quanto na DM2&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">O diagn&#243;stico precoce da cardiomiopatia diab&#233;tica &#233; clinicamente &#250;til&#44; uma vez que as les&#245;es iniciais podem ser revers&#237;veis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">4&#44;5</span></a> No entanto&#44; ainda &#233; uma condi&#231;&#227;o pouco reconhecida pelos cl&#237;nicos&#44; uma vez que pode exigir ferramentas mais sens&#237;veis para diagn&#243;stico e pela controv&#233;rsia dos resultados de estudos pr&#233;vios com diferentes m&#233;todos de avalia&#231;&#227;o e amostras heterog&#234;neas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da disfun&#231;&#227;o diast&#243;lica &#233; essencial para o entendimento da fun&#231;&#227;o card&#237;aca&#46; &#201; determinada simplificadamente pela altera&#231;&#227;o no relaxamento ventricular esquerdo e pelo aumento da rigidez mioc&#225;rdica&#46; &#201; evidenciada nas cardiomiopatias e est&#225; associada a progn&#243;stico mais desfavor&#225;vel&#44; incluindo mortalidade e hospitaliza&#231;&#227;o por insufici&#234;ncia card&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Considera&#8208;se a disfun&#231;&#227;o diast&#243;lica a altera&#231;&#227;o inicial da cardiomiopatia diab&#233;tica e ocorre em 27 a 69&#37; das pessoas assintom&#225;ticas com diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Um m&#233;todo sens&#237;vel para a avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica &#233; o Doppler tecidular&#44; que mede velocidades como e&#8217; &#40;velocidade diast&#243;lica precoce&#41;&#46; Esse &#233; um dos principais par&#226;metros na avalia&#231;&#227;o diast&#243;lica&#44; com maior reprodutibilidade e mais associado a desfechos cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Na DM1&#44; as velocidades e&#8217; e a rela&#231;&#227;o e&#8217;&#47;a&#8217; s&#227;o menores em rela&#231;&#227;o a controlos sadios&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Apesar de as diferen&#231;as nos par&#226;metros de avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica entre indiv&#237;duos com DM1 e controlos terem sido relatadas em v&#225;rios estudos pr&#233;vios&#44; no acompanhamento em longo prazo de indiv&#237;duos com DM1 n&#227;o houve maior incid&#234;ncia de disfun&#231;&#227;o diast&#243;lica naqueles sem hipertens&#227;o ou doen&#231;a coron&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> Discute&#8208;se a possibilidade de que o tratamento com reposi&#231;&#227;o de insulina normalize os desarranjos metab&#243;licos da hiperglicemia&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Com a progress&#227;o da cardiomiopatia diab&#233;tica&#44; admite&#8208;se o aumento do risco de desenvolvimento da insufici&#234;ncia card&#237;aca&#46; Especificamente em rela&#231;&#227;o &#224; DM1&#44; observou&#8208;se n&#227;o s&#243; a associa&#231;&#227;o entre DM1 e insufici&#234;ncia card&#237;aca como tamb&#233;m sua rela&#231;&#227;o com o controlo glic&#234;mico&#44; idade e dura&#231;&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Argumenta&#8208;se que a cardiomiopatia diab&#233;tica apresente diferentes fen&#243;tipos&#44; um deles representado pela disfun&#231;&#227;o diast&#243;lica e outro&#44; pela disfun&#231;&#227;o sist&#243;lica&#44; ambos determinando insufici&#234;ncia card&#237;aca&#44; e n&#227;o se tratando simplesmente de diferentes est&#225;gios evolutivos&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A incorpora&#231;&#227;o de novas t&#233;cnicas&#44; como o <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico na ecocardiografia&#44; tem por objetivo aumentar a sensibilidade diagn&#243;stica do m&#233;todo&#44; principalmente para disfun&#231;&#227;o mioc&#225;rdica subcl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">15&#44;16</span></a> O par&#226;metro mais utilizado &#233; o <span class="elsevierStyleItalic">strain</span> longitudinal global&#44; que se refere &#224; m&#233;dia do <span class="elsevierStyleItalic">strain</span> dos segmentos mioc&#225;rdicos no sentido longitudinal&#44; mais reprodut&#237;vel&#44; capaz de identificar disfun&#231;&#227;o subcl&#237;nica do ventr&#237;culo esquerdo &#40;VE&#41; e considerado um melhor preditor de risco do que a fra&#231;&#227;o de eje&#231;&#227;o do VE&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">17&#44;18</span></a> Demonstrou&#8208;se disfun&#231;&#227;o sist&#243;lica incipiente na DM1 atrav&#233;s de redu&#231;&#227;o do valor absoluto do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">19&#8211;23</span></a> Enquanto outros estudos associaram valores reduzidos de <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico ao controlo glic&#234;mico<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24&#44;25</span></a> ou &#224; presen&#231;a de complica&#231;&#245;es como nefropatia diab&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">26</span></a> Percebe&#8208;se com base na literatura resultados conflitantes em rela&#231;&#227;o &#224; disfun&#231;&#227;o sist&#243;lica subcl&#237;nica&#44; que poderia ser explicada em fun&#231;&#227;o da heterogeneidade da popula&#231;&#227;o estudada quanto &#224; presen&#231;a de comorbidades&#44; controlo glic&#234;mico&#44; tamanho da amostra&#44; idade&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">O presente estudo visa a identificar les&#245;es card&#237;acas precoces secund&#225;rias &#224; DM1 atrav&#233;s da ecocardiografia e atrav&#233;s de ecocardiografia bidimensional convencional com Doppler e avan&#231;ada com <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking&#46;</span></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; anal&#237;tico&#44; do tipo caso&#8208;controlo&#46; A amostra foi composta de 42 pacientes com diagn&#243;stico de DM1 e idade maior que 18 anos&#44; que se encontravam em seguimento ou apresentaram hist&#243;rico de consulta no ambulat&#243;rio de endocrinologia&#46; Foram inclu&#237;dos&#44; como grupo controlo&#44; 42 indiv&#237;duos sem diabetes e sem doen&#231;as cr&#244;nicas&#44; em sua maioria profissionais da sa&#250;de e funcion&#225;rios do mesmo hospital&#44; selecionados a partir de idade e sexo&#46; A sele&#231;&#227;o dos participantes iniciou em julho de 2018 e terminou em agosto de 2019&#44; consecutivamente respeitando os crit&#233;rios de inclus&#227;o e exclus&#227;o&#46; Para cumprir os requisitos &#233;ticos&#44; foi submetido e aprovado pelo comit&#234; de &#233;tica da institui&#231;&#227;o &#40;CAAE&#58; 24822114&#46;5&#46;0000&#46;0121&#41; conforme descrito na resolu&#231;&#227;o 466&#47;2012 do CNS&#46; Todos os participantes assinaram o termo de consentimento livre e esclarecido previamente a sua inclus&#227;o no estudo&#46; Foram 80 participantes que respeitaram os crit&#233;rios de exclus&#227;o&#58; &#40;1&#41; hipertens&#227;o arterial sist&#234;mica&#59; &#40;2&#41; suspeita ou diagn&#243;stico de doen&#231;a coron&#225;ria atrav&#233;s da hist&#243;ria cl&#237;nica &#40;sintomas ou hist&#243;rico de doen&#231;a coron&#225;ria&#41;&#59; &#40;3&#41; les&#227;o valvar significativa &#40;estenose ou insufici&#234;ncia valvar de grau maior do que ligeira&#41;&#59; &#40;4&#41; disfun&#231;&#227;o mioc&#225;rdica pr&#233;via ou diagn&#243;stico de cardiomiopatia&#59; &#40;5&#41; hist&#243;ria de radio ou quimioterapia&#59; &#40;6&#41; etilismo&#59; &#40;7&#41; janela ac&#250;stica limitada &#40;casos em que mais de dois segmentos mioc&#225;rdicos n&#227;o puderam ser visibilizados&#41;&#59; &#40;8&#41; recusa a participar do estudo&#46; Em cada grupo&#44; dois participantes foram exclu&#237;dos por janela ac&#250;stica limitada&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As vari&#225;veis cl&#237;nico&#8208;demogr&#225;ficas dos participantes foram obtidas atrav&#233;s de anamnese dos participantes&#46; Esta incluiu os seguintes dados&#58; idade&#44; idade do diagn&#243;stico de DM1&#44; epis&#243;dios de hipoglicemia ao m&#234;s&#44; hist&#243;ria de interna&#231;&#227;o por complica&#231;&#245;es referentes &#224; DM1&#44; dados antropom&#233;tricos&#44; h&#225;bitos de vida&#44; comorbidades&#44; complica&#231;&#245;es da DM1 e uso de medica&#231;&#245;es&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os seguintes exames laboratoriais foram coletados com jejum de 8 a 12 horas&#58; &#40;1&#41; hemoglobina &#40;g&#47;dl&#41;&#59; &#40;2&#41; glicemia de jejum &#40;mg&#47;dl&#41;&#59; &#40;3&#41; HbA1c &#40;&#37;&#41;&#59; &#40;4&#41; creatinina &#40;mg&#47;dl&#41;&#59; &#40;5&#41; microalbumin&#250;ria ou rela&#231;&#227;o albumina&#47;creatinina ou rela&#231;&#227;o prote&#237;na&#47;creatinina em amostra isolada de urina &#40;mg&#47;g&#41;&#59; &#40;6&#41; colesterol total &#40;mg&#47;dl&#41;&#59; &#40;7&#41; HDL &#40;mg&#47;dl&#41;&#59; &#40;8&#41; triglicer&#237;deos &#40;mg&#47;dl&#41;&#59; &#40;9&#41; LDL &#40;mg&#47;dl&#41;&#59; &#40;10&#41; TSH &#40;&#956;g&#41;&#46; O c&#225;lculo do <span class="elsevierStyleItalic">clearance</span> de creatinina foi realizado atrav&#233;s da equa&#231;&#227;o CKD&#8208;EPI&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">27</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica de todos os pacientes foi realizada por um &#250;nico ecocardiografista &#40;TRWS&#41;&#44; seguindo as recomenda&#231;&#245;es para quantifica&#231;&#227;o de c&#226;maras card&#237;acas pela Sociedade Americana de Ecocardiografia e Associa&#231;&#227;o Europeia de Imagem Cardiovascular&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">28</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">As imagens foram adquiridas em dec&#250;bito lateral esquerdo atrav&#233;s do equipamento GE S6 com transdutor 1&#44;5&#8211;3&#44;6<span class="elsevierStyleHsp" style=""></span>MHz&#44; utilizando as janelas ecocardiogr&#225;ficas&#58; paraesternal&#44; apical&#44; subcostal e supraesternal e armazenadas em m&#237;dia digital para futuras an&#225;lises e revis&#245;es&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Pelo corte longitudinal paraesternal&#44; obtiveram&#8208;se as seguintes medidas no fim da di&#225;stole ventricular&#58; espessura do septo interventricular &#40;SIV&#41; e da parede posterior do VE &#40;PPVE&#41;&#44; di&#226;metro diast&#243;lico do VE &#40;DDVE&#41; e di&#226;metro dos seios a&#243;rticos&#46; O c&#225;lculo da massa ventricular foi obtido atrav&#233;s da f&#243;rmula 0&#44;8 x 1&#44;04 x &#91;&#40;SIV &#43;DDVE &#43; PPVE&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a> &#8211; DDVE<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a>&#93; &#43; 0&#44;6<span class="elsevierStyleHsp" style=""></span>g&#44; utilizando o m&#233;todo linear com medidas realizadas ao ecocardiograma bidimensional&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o sist&#243;lica global do VE foi avaliada atrav&#233;s da fra&#231;&#227;o de eje&#231;&#227;o pelo m&#233;todo Simpson nas janelas apicais de 4 e 2 c&#226;maras e do <span class="elsevierStyleItalic">strain</span> longitudinal sist&#243;lico de pico pela ecocardiografia com <span class="elsevierStyleItalic">speckle tracking bidimensional &#40;2<span class="elsevierStyleHsp" style=""></span>DSTE&#41;</span> nas janelas apicais de 3&#44; 4 e 2 c&#226;maras&#44; para obten&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> global longitudinal do VE &#40;<span class="elsevierStyleItalic">GLSVE</span>&#41;&#46; Para a aquisi&#231;&#227;o das imagens&#44; aprimorou&#8208;se a qualidade da imagem&#44; com a frequ&#234;ncia de quadros maximizada &#40;60 a 90 quadros por segundo&#41;&#44; o encurtamento minimizado e o registro de pelo menos 3 batimentos&#44; durante apneia no fim da expira&#231;&#227;o&#46; Para an&#225;lise do <span class="elsevierStyleItalic">GLSVE</span>&#44; utilizou&#8208;se o <span class="elsevierStyleItalic">AFI</span> &#40;<span class="elsevierStyleItalic">automated funcion imaging</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">A an&#225;lise da fun&#231;&#227;o diast&#243;lica do VE incluiu as velocidades diast&#243;licas precoce &#40;E&#41; e tardia &#40;A&#41; do pico do fluxo transmitral aferidas na extremidade das c&#250;spides da valva mitral&#44; as velocidades diast&#243;licas precoce &#40;e&#8217;&#41; e tardia &#40;a&#8217;&#41; registradas ao Doppler tecidular no anel mitral septal e lateral&#59; rela&#231;&#227;o entre as velocidades E&#47;A do fluxo transvalvar mitral&#44; rela&#231;&#227;o entre as velocidades E&#47;valor m&#233;dio de e&#769; septal e lateral&#44; tempo de desacelera&#231;&#227;o da velocidade E&#44; intervalo de relaxamento isovolum&#233;trico&#44; ondas sist&#243;lica &#40;S&#41; e diast&#243;lica &#40;D&#41; do fluxo das veias pulmonares&#44; volume atrial esquerdo indexado pelo superf&#237;cie corp&#243;rea &#40;SC&#41; atrav&#233;s da m&#233;dia do volume no corte apical 4 c&#226;maras e no apical 2 c&#226;maras&#44; rela&#231;&#227;o das ondas S&#47;D do fluxo das veias pulmonares&#44; velocidade do jato de regurgita&#231;&#227;o tric&#250;spide&#44; se presente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As medidas do ventr&#237;culo direito &#40;VD&#41; foram obtidas no corte apical 4 c&#226;maras com foco no ventr&#237;culo direito&#46; A fun&#231;&#227;o sist&#243;lica do VD foi avaliada atrav&#233;s dos par&#226;metros&#58; excurs&#227;o sist&#243;lica do anel tric&#250;spide &#40;TAPSE&#41;&#44; varia&#231;&#227;o sist&#243;lica das &#225;reas do VD &#40;FAC&#41;&#44; velocidade m&#225;xima da onda S&#8217; ao Doppler tecidular e <span class="elsevierStyleItalic">strain</span> global longitudinal do VD por <span class="elsevierStyleItalic">speckle tracking</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#44; utilizando a m&#233;dia do <span class="elsevierStyleItalic">strain</span> longitudinal sist&#243;lico de pico dos tr&#234;s segmentos da parede livre do VD&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o diast&#243;lica do VD foi avaliada pela rela&#231;&#227;o E&#47;A&#44; tempo de desacelera&#231;&#227;o da onda E&#44; rela&#231;&#227;o E&#47;e&#769; e volume atrial direito indexado pela SC&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lise estat&#237;stica</span><p id="par0100" class="elsevierStylePara elsevierViewall">O tamanho da amostra foi estimado em 28 indiv&#237;duos em cada grupo com a finalidade de poder detectar uma diferen&#231;a de 1&#37; no <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico pelo m&#233;todo de <span class="elsevierStyleItalic">speckle tracking</span>&#44; quando comparados ao grupo controlo&#44; considerando um valor m&#233;dio de <span class="elsevierStyleItalic">strain</span> global longitudinal por <span class="elsevierStyleItalic">speckle tracking</span> &#8208;20&#44;3&#37; com desvio&#8208;padr&#227;o 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a> Foram utilizados para o c&#225;lculo amostral um n&#237;vel de signific&#226;ncia de 5&#37; e um n&#237;vel de poder estat&#237;stico de 95&#37;&#44; para teste bicaudado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Foi realizado o teste de Shapiro&#8208;Wilk para avaliar normalidade da distribui&#231;&#227;o de cada vari&#225;vel&#46; As vari&#225;veis cont&#237;nuas foram descritas como m&#233;dia com desvio&#8208;padr&#227;o&#44; sendo comparadas pelo teste <span class="elsevierStyleItalic">t</span> de Student&#44; quando com distribui&#231;&#227;o normal&#44; ou pelo teste de Mann&#8208;Whitney&#44; quando n&#227;o normalmente distribu&#237;das&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">As vari&#225;veis categ&#243;ricas foram descritas como percentagem ou frequ&#234;ncia e comparadas com o teste do qui&#8208;quadrado&#46; Os potenciais preditores de fun&#231;&#227;o ventricular foram avaliados calculando&#8208;se os coeficientes de correla&#231;&#227;o &#40;r<span class="elsevierStyleSup">2</span>&#41; atrav&#233;s do m&#233;todo de Pearson ou Spearman&#46; Todos os dados coletados foram armazenados e os c&#225;lculos estat&#237;sticos foram realizados no programa R para Windows&#44; vers&#227;o 3&#46;5&#46;3 &#40;<span class="elsevierStyleItalic">R Foundation</span>&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0115" class="elsevierStylePara elsevierViewall">A idade m&#233;dia do grupo DM1 foi de 32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 anos &#40;20 a 50 anos&#41; e do grupo controlo&#44; de 32&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 anos &#40;23 a 46 anos&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;89&#41;&#46; Em rela&#231;&#227;o ao g&#234;nero&#44; 55&#37; dos participantes de ambos os grupos eram mulheres&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Referente aos dados antropom&#233;tricos&#44; os dois grupos apresentaram &#237;ndice de massa corp&#243;rea m&#233;dio de 24&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; No grupo DM1&#44; 30&#37; dos pacientes estavam com sobrepeso e&#44; no grupo controlo&#44; 37&#44;5&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;77&#41;&#46; A obesidade foi observada em quatro indiv&#237;duos de cada grupo &#40;10&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No grupo DM1&#44; a idade m&#233;dia em que o diagn&#243;stico de DM1 ocorreu foi aos 15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;1 anos &#40;3 a 38 anos&#41; e dura&#231;&#227;o m&#233;dia do DM1 de 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3 anos &#40;2 a 38 anos&#41;&#46; Vinte por cento tinham retinopatia diab&#233;tica&#59; 12&#44;5&#37;&#44; ind&#237;cio de les&#227;o renal pelo DM1 pela presen&#231;a de microalbumin&#250;ria ou equivalente e 10&#37;&#44; neuropatia perif&#233;rica&#46; A ocorr&#234;ncia de hipoglicemias ao m&#234;s foi de 9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8 epis&#243;dios&#46; Nenhum paciente com DM1 foi internado no &#250;ltimo ano por complica&#231;&#245;es relacionadas ao diabetes&#46; A press&#227;o arterial sist&#243;lica m&#233;dia dos doentes com DM1 foi de 109&#44;7<span class="elsevierStyleHsp" style=""></span>mmHg e dos indiv&#237;duos no grupo controlo de 102&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e a press&#227;o diast&#243;lica m&#233;dia de 63&#44;7<span class="elsevierStyleHsp" style=""></span>mmHg dos doentes com DM1 e de 68&#44;6<span class="elsevierStyleHsp" style=""></span>mmHg nos controlos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quanto aos h&#225;bitos de vida&#44; 5&#37; dos pacientes com diabetes fumavam e 10&#37; eram ex&#8208;tabagistas&#59; no grupo controlo&#44; quase 8&#37; dos controlos fumavam&#44; os demais eram n&#227;o tabagistas&#46; A m&#233;dia de atividade f&#237;sica foi de 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>161 minutos por semana no grupo com DM1 e 141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>134 minutos por semana&#44; no grupo controlo &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos e os exames laboratoriais avaliados no estudo est&#227;o descritos na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A an&#225;lise ecocardiogr&#225;fica ao bidimensional demonstrou tamanhos semelhantes das c&#226;maras card&#237;acas&#44; sem diferen&#231;a no &#237;ndice de massa ventricular e na fun&#231;&#227;o sist&#243;lica atrav&#233;s do m&#233;todo Simpson&#46; N&#227;o houve diferen&#231;as nos &#237;ndices de desempenho card&#237;aco como volume sist&#243;lico e d&#233;bito card&#237;aco entre os grupos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O uso de Doppler tecidular para avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica do VE evidenciou redu&#231;&#227;o da velocidade diast&#243;lica precoce &#40;E&#8217; lateral&#41; e do valor m&#233;dio das velocidades diast&#243;licas precoces &#40;E&#8217; m&#233;dio&#41; e maior tempo de desacelera&#231;&#227;o da velocidade&#46; E no grupo DM1&#46; Outro par&#226;metro relacionado &#224; fun&#231;&#227;o diast&#243;lica do VE com diferen&#231;a entre os grupos&#44; menor no grupo com DM1&#44; foi a rela&#231;&#227;o S&#47;D&#46; &#205;ndices de fun&#231;&#227;o diast&#243;lica do VD como E&#8217; tric&#250;spide e rela&#231;&#227;o E&#8217;&#47;A&#8217; encontravam&#8208;se reduzidos no grupo DM1 em rela&#231;&#227;o ao controlo&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; aplica&#231;&#227;o do m&#233;todo de <span class="elsevierStyleItalic">speckle tracking</span> para quantifica&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico no VE&#44; n&#227;o se observaram diferen&#231;as no <span class="elsevierStyleItalic">strain</span> global longitudinal do VE entre os grupos&#46; No ventr&#237;culo direito&#44; o <span class="elsevierStyleItalic">strain</span> global longitudinal m&#233;dio foi similar em ambos os grupos&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Os demais dados ecocardiogr&#225;ficos coletados no estudo est&#227;o descritos na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">O par&#226;metro de fun&#231;&#227;o diast&#243;lica e&#8217; m&#233;dio apresentou correla&#231;&#227;o com os valores de HbA1c e tempo de dura&#231;&#227;o do DM &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8208;0&#44;33 e &#8208;0&#44;41&#59; respectivamente&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e o tempo de desacelera&#231;&#227;o&#44; com os valores de HbA1c &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;51&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; N&#227;o houve correla&#231;&#227;o entre os &#237;ndices de fun&#231;&#227;o sist&#243;lica e as vari&#225;veis cl&#237;nicas ou laboratoriais&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0165" class="elsevierStylePara elsevierViewall">O uso de novas t&#233;cnicas de imagem para diagn&#243;stico de cardiomiopatia diab&#233;tica tem propiciado a constru&#231;&#227;o de um maior conhecimento&#44; pela identifica&#231;&#227;o de les&#245;es mais precoces&#44; apesar de existirem resultados conflitantes&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">23&#44;26</span></a> possivelmente devido &#224; heterogeneidade da popula&#231;&#227;o estudada quanto aos aspectos demogr&#225;ficos e quanto &#224;s suas comorbidades&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A proposta deste trabalho foi estudar altera&#231;&#245;es card&#237;acas estruturais e funcionais relacionadas &#224; cardiomiopatia diab&#233;tica&#44; sem a interfer&#234;ncia de outras comorbidades que sabidamente causam les&#245;es card&#237;acas como por exemplo a hipertens&#227;o arterial sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">18</span></a> Tamb&#233;m n&#227;o houve internamentos por complica&#231;&#245;es de diabetes no &#250;ltimo ano&#44; o que poderia influenciar a avalia&#231;&#227;o card&#237;aca&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Os grupos selecionados eram compar&#225;veis&#44; uma vez que apresentaram caracter&#237;sticas gerais semelhantes&#58; idade m&#233;dia&#44; propor&#231;&#227;o de g&#234;nero masculino e feminino e &#237;ndice de massa corp&#243;rea&#59; condi&#231;&#245;es que determinam diferen&#231;as nos valores do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">No que se refere a complica&#231;&#245;es microvasculares&#44; a preval&#234;ncia de retinopatia foi menor do que a esperada para esta dura&#231;&#227;o m&#233;dia da DM1&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">31</span></a> Isso pode ser explicado pelo fato de a hipertens&#227;o arterial sist&#234;mica ser um crit&#233;rio de exclus&#227;o do estudo e considerando que a preval&#234;ncia de retinopatia est&#225; relacionada n&#227;o s&#243; &#224; dura&#231;&#227;o da DM1&#44; mas tamb&#233;m ao controlo glic&#234;mico e aos n&#237;veis press&#243;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">32</span></a> Independentemente&#44; n&#227;o se observa associa&#231;&#227;o da retinopatia diab&#233;tica com o desenvolvimento de doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">33</span></a> Em rela&#231;&#227;o &#224; les&#227;o renal&#44; definida pela evid&#234;ncia de protein&#250;ria&#44; houve preval&#234;ncia similar ao descrito na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">34</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica demonstrou redu&#231;&#227;o dos valores de E&#8217; mitral tanto da parede lateral quanto do valor m&#233;dio de E&#8217; entre septo e lateral&#44; que representa uma das vari&#225;veis mais robustas na an&#225;lise da fun&#231;&#227;o diast&#243;lica do VE&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Esse achado foi observado em outros trabalhos da literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a> N&#227;o houve casos de disfun&#231;&#227;o diast&#243;lica do VE &#40;utilizando algoritmo atual<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a>&#41; nem foi encontrado valor fora da normalidade para a faixa et&#225;ria dos indiv&#237;duos&#46; No entanto&#44; a redu&#231;&#227;o dos valores dessa vari&#225;vel no grupo DM1 sup&#245;e redu&#231;&#227;o da capacidade de relaxamento mioc&#225;rdico&#44; do mesmo modo que esses valores tamb&#233;m diminuem com o envelhecimento&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Houve diferen&#231;a entre outras duas vari&#225;veis utilizadas na an&#225;lise da fun&#231;&#227;o diast&#243;lica&#58; tempo de desacelera&#231;&#227;o da onda E e na rela&#231;&#227;o entre as ondas S &#40;sist&#243;lica&#41; e D &#40;diast&#243;lica&#41;&#46; O tempo de desacelera&#231;&#227;o da onda E est&#225; relacionado ao relaxamento e &#224; distensibilidade do VE&#44; um dos componentes determinantes da fun&#231;&#227;o diast&#243;lica do VE&#46; A velocidade da onda S est&#225; relacionada &#224; press&#227;o atrial esquerda&#44; contratilidade do &#225;trio esquerdo e contratilidade do ventr&#237;culo direito&#46; A velocidade da onda D &#233; influenciada principalmente pelo enchimento diast&#243;lico precoce do VE&#46; Diferen&#231;as nessas vari&#225;veis entre os grupos DM1 e controlo constituem mais um ind&#237;cio de disfun&#231;&#227;o diast&#243;lica do VE subcl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">7&#44;35</span></a> De fato&#44; n&#227;o houve diferen&#231;a entre volume atrial esquerdo indexado para a superf&#237;cie corp&#243;rea entre os grupos&#46; Este &#250;ltimo&#44; marcador da gravidade de disfun&#231;&#227;o diast&#243;lica&#44; reflete o efeito cumulativo das press&#245;es de enchimento com o tempo&#46; <a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">36&#44;37</span></a> Levanta&#8208;se a hip&#243;tese de que outras vari&#225;veis como o <span class="elsevierStyleItalic">strain</span> atrial esquerdo&#44; muito associado &#224; press&#227;o atrial esquerda e em estudo nas miocardiopatias&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a> poderiam contribuir na avalia&#231;&#227;o desses pacientes&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">A m&#233;dia do <span class="elsevierStyleItalic">strain</span> longitudinal global do VE encontrado no grupo controlo &#40;&#8208;21&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#41; foi semelhante aos valores de normalidade &#40;&#8208;21&#44;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#41; apresentados na literatura para o mesmo <span class="elsevierStyleItalic">software</span> utilizado&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">28&#44;39</span></a> Outro achado condizente com a literatura foi a diferen&#231;a do valor do <span class="elsevierStyleItalic">strain</span> longitudinal global do VE relacionado ao g&#234;nero&#44; sendo mais negativo no sexo feminino em compara&#231;&#227;o ao masculino&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29&#44;39</span></a> N&#227;o houve diferen&#231;a no valor de <span class="elsevierStyleItalic">strain</span> global longitudinal entre os grupos tanto do VE quanto do VD&#46; No que se refere ao VE&#44; a aus&#234;ncia de diferen&#231;as na fun&#231;&#227;o sist&#243;lica ventricular pode estar relacionada &#224; aus&#234;ncia de hipertens&#227;o e outras comorbidades como hist&#243;ria de doen&#231;a coron&#225;ria na popula&#231;&#227;o estudada&#44; o que pode ser um fator de confus&#227;o nos estudos pr&#233;vios&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">8&#44;26</span></a> Tamb&#233;m deve&#8208;se considerar que poucos pacientes com DM1 apresentaram n&#237;veis glic&#234;micos elevados&#44; o que poderia reduzir a manifesta&#231;&#227;o de cardiomiopatia diab&#233;tica nos pacientes com DM1&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Observou&#8208;se&#44; no entanto&#44; maior <span class="elsevierStyleItalic">strain</span> longitudinal de pico sist&#243;lico no segmento basal do VD em rela&#231;&#227;o ao grupo controlo&#46; Esse achado n&#227;o foi demonstrado nos demais segmentos do ventr&#237;culo direito nem houve diferen&#231;a na m&#233;dia do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico do ventr&#237;culo direito &#40;<span class="elsevierStyleItalic">strain</span> global longitudinal do VD&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Referente ao ventr&#237;culo direito&#44; demonstrou&#8208;se redu&#231;&#227;o das ondas E&#8217; tric&#250;spide&#44; o que infere redu&#231;&#227;o da capacidade de relaxamento mioc&#225;rdica do ventr&#237;culo direito&#44; par&#226;metro utilizado na avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica do ventr&#237;culo direito&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limita&#231;&#245;es</span><p id="par0210" class="elsevierStylePara elsevierViewall">Todos os exames ecocardiogr&#225;ficos foram realizados uma &#250;nica vez&#46; Desse modo&#44; n&#227;o foi poss&#237;vel avaliar a variabilidade intra e interoperadores&#46; Contudo&#44; descreve&#8208;se na literatura boa reprodutibilidade do m&#233;todo&#44; permitindo aplica&#231;&#227;o desses resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Apesar de o tamanho da amostra ter sido adequado para se demonstrar a diferen&#231;a desejada tanto na fun&#231;&#227;o sist&#243;lica quanto diast&#243;lica&#44; a avalia&#231;&#227;o de um maior n&#250;mero de pacientes seria interessante para confirmar esses resultados&#46; Al&#233;m disso&#44; n&#227;o houve seguimento dos pacientes para que se possa inferir qual a evolu&#231;&#227;o cl&#237;nica e ecocardiogr&#225;fica&#44; sobretudo dos par&#226;metros estudados&#46; Apesar de previamente determinadas em m&#233;todo da pesquisa&#44; foram realizadas compara&#231;&#245;es m&#250;ltiplas&#44; aumentando a probabilidade de algumas diferen&#231;as encontradas serem ao acaso&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclus&#227;o</span><p id="par0220" class="elsevierStylePara elsevierViewall">Mesmo comparando pessoas assintom&#225;ticas com DM1&#44; observa&#8208;se diferen&#231;a nos par&#226;metros de avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica biventricular em rela&#231;&#227;o aos controlos&#44; o que pode denotar uma redu&#231;&#227;o sutil da fun&#231;&#227;o card&#237;aca nesses pacientes e poss&#237;vel cardiomiopatia diab&#233;tica incipiente&#46; No entanto&#44; quanto &#224; fun&#231;&#227;o sist&#243;lica de ambos os ventr&#237;culos&#44; n&#227;o houve diferen&#231;a entre os dois grupos utilizando <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking</span>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiamento</span><p id="par0225" class="elsevierStylePara elsevierViewall">Ger&#234;ncia de Ensino e Pesquisa do Hospital Universit&#225;rio Professor Polydoro Ernani de S&#227;o Thiago&#44; Universidade Federal de Santa Catarina&#44; Brasil&#44; atrav&#233;s de financiamento pr&#243;prio &#40;GEP &#8208; protocolo 029&#41;&#44; para custear os exames laboratoriais dos indiv&#237;duos do grupo controlo&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflitos de interesse</span><p id="par0230" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diabetes <span class="elsevierStyleItalic">mellitu</span>s tipo 1 &#40;DM1&#41; &#233; uma doen&#231;a cr&#244;nica com pico de incid&#234;ncia na adolesc&#234;ncia&#44; com grande impacto na morbimortalidade&#44; principalmente cardiovascular&#46; A cardiomiopatia diab&#233;tica caracteriza&#8208;se por les&#245;es estruturais e funcionais na aus&#234;ncia de outras doen&#231;as&#59; e est&#225; implicada na progress&#227;o para insufici&#234;ncia card&#237;aca&#46; A ecocardiografia tem propiciado a identifica&#231;&#227;o de les&#245;es card&#237;acas precoces&#44; apesar de resultados controversos na DM1&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar altera&#231;&#245;es card&#237;acas em indiv&#237;duos com DM1 em compara&#231;&#227;o ao controlo &#40;pessoas sem comorbidades&#41; atrav&#233;s de ecocardiografia bidimensional convencional com Doppler e avan&#231;ada com <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking&#46;</span></p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo caso&#8208;controlo com 40 pacientes com DM1 de 20 a 50 anos&#44; assintom&#225;ticos&#44; normotensos&#44; e 40 controlos&#46; Avalia&#231;&#227;o ecocardiogr&#225;fica em modo bidimensional foi realizada para medida de espessura mioc&#225;rdica e das c&#226;maras card&#237;acas&#44; uso de Doppler tecidular na an&#225;lise diast&#243;lica e <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking</span> para quantificar a fun&#231;&#227;o sist&#243;lica ventricular&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Idade m&#233;dia foi de 33 anos em ambos os grupos&#44; com dura&#231;&#227;o m&#233;dia da DM1 de 18 anos&#44; 20&#37; dos pacientes com diabetes apresentaram retinopatia diab&#233;tica&#59; 12&#44;5&#37;&#44; les&#227;o renal&#59; e 10&#37;&#44; neuropatia perif&#233;rica&#46; Houve diferen&#231;as na fun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo &#40;E&#8217; lateral&#44; E&#8217; m&#233;dio e rela&#231;&#227;o S&#47;D&#41; e do ventr&#237;culo direito &#40;E&#8217; tric&#250;spide e rela&#231;&#227;o E&#8217;&#47;A&#8217; tric&#250;spide&#41;&#46; O valor m&#233;dio do <span class="elsevierStyleItalic">strain</span> global longitudinal foi &#8208;21&#44;7&#37; &#40;&#43;&#8208; 2&#44;3&#41; no grupo DM1 e &#8208;21&#44;0&#37; &#40;&#43;&#8208;2&#44;0&#41; no controlo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;21&#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 avalia&#231;&#227;o ecocardiogr&#225;fica identificou redu&#231;&#227;o nos &#237;ndices de fun&#231;&#227;o diast&#243;lica na DM1 em compara&#231;&#227;o ao controlo&#44; que pode constituir a les&#227;o card&#237;aca inicial na diabetes&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamento"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Type 1 diabetes &#40;T1D&#41; is a chronic disease with peak incidence in adolescence&#59; it has a major impact on morbidity and mortality&#44; especially cardiovascular&#46; Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure&#46; Echocardiography has led to the identification of early cardiac lesions&#44; despite controversial results in the literature in patients with T1D&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two&#8208;dimensional Doppler and advanced speckle tracking echocardiography&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">This is a case&#8208;control study with 40 asymptomatic&#44; normotensive T1D patients aged 20 to 50 years and 40 healthy subjects&#46; Two&#8208;dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers&#46; Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">The mean age was 33 years in both groups&#44; with an average T1D duration of 18 years&#59; 20&#37; of patients with T1D had diabetic retinopathy&#59; 12&#46;5&#37; kidney injury&#59; and 10&#37; peripheral neuropathy&#46; There were differences in the left ventricular diastolic function parameters &#40;lateral E&#8217;&#44; middle E&#8217; and S&#47;D ratio&#41; and right ventricle &#40;tricuspid E and tricuspid E&#8217;&#47;A&#8217; ratio&#41;&#46; The mean value of the global longitudinal strain was &#8208;21&#46;7&#37; &#40;&#43;&#8208; 2&#46;3&#41; in the T1D group and &#8208;21&#46;0&#37; &#40;&#43;&#8208;2&#46;0&#41; in the control group &#40;p&#61;0&#46;21&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Echocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group&#44; which may be the initial cardiac lesion in diabetes&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1893
            "Ancho" => 2175
            "Tamanyo" => 324524
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise do <span class="elsevierStyleItalic">strain</span> longitudinal global do ventr&#237;culo esquerdo pela 2 DSTE&#46; C&#225;lculo do <span class="elsevierStyleItalic">strain</span> longitudinal global pela 2 DSTE&#44; atrav&#233;s de AFI&#46; Na &#64257;gura&#44; o <span class="elsevierStyleItalic">strain</span> global longitudinal do ventr&#237;culo esquerdo obtido foi de &#8208;23&#44;5&#37; em paciente com diabetes mellitus tipo 1&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1460
            "Ancho" => 2175
            "Tamanyo" => 376860
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise do strain longitudinal global do ventr&#237;culo direito pela 2DSTE&#46; Strain longitudinal global do ventr&#237;culo direito&#44; obtido pela m&#233;dia do strain dos tr&#234;s segmentos da parede livre do ventr&#237;culo direito em paciente com diabetes mellitus tipo 1&#46; Neste caso&#44; estimado em &#8208;30&#44;6&#37;&#46; Observa&#231;&#227;o&#58; o valor demonstrado na&#160;&#64257;gura considerou os segmentos da parede septal para c&#225;lculo do strain&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Valores apresentados como m&#233;dia e respetivo desvio padr&#227;o &#40;&#177;&#41; ou porcentagem absoluta&#46; Atividade F&#237;sica descrita em minutos por semana &#40;autodeclarada&#41;&#46; HDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>lipoprote&#237;na de alta densidade&#59; LDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>lipoprote&#237;nas de baixa densidade&#59; TSH<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>horm&#244;nio tireoestimulante&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo DM1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;89&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">Sexo &#40;feminino&#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
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                  \t\t\t\t">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&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">IMC&nbsp;\t\t\t\t\t\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">24&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;39&nbsp;\t\t\t\t\t\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">24&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;42&nbsp;\t\t\t\t\t\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;96&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">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">Atividade F&#237;sica &#40;min&#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">135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>161&nbsp;\t\t\t\t\t\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">141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>134&nbsp;\t\t\t\t\t\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;86&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
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                  \t\t\t\t">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">47&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">Hipotireodismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&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">Hemoglobina &#40;g&#47;dl&#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
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                  \t\t\t\t">14&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&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">Aorta ascendente &#40;mm&#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
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                  \t\t\t\t">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;75&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">SIV &#40;mm&#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
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;04&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">PPVE &#40;mm&#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
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                  \t\t\t\t">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#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
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                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;31&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">DDVE &#40;mm&#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
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                  \t\t\t\t">49&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&#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
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                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;20&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">DSVE &#40;mm&#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
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                  \t\t\t\t">29&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;24&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">VAE&#47;SC &#40;ml&#47;m<span class="elsevierStyleSup">2</span>&#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
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                  \t\t\t\t">23&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;16&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">IM&#47;SC &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#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
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                  \t\t\t\t">60&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;83&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">FEVE &#40;Teichholz&#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
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                  \t\t\t\t">71&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;40&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">FEVE &#40;Simpson&#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
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                  \t\t\t\t">71&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;79&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">GLS VE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;21&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">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
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                  \t\t\t\t">&#8208;21&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;21&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">Volume sist&#243;lico &#40;ml&#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
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                  \t\t\t\t">61&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#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
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                  \t\t\t\t">65&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#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
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                  \t\t\t\t">0&#44;26&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">D&#233;bito card&#237;aco &#40;L&#47;min&#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
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                  \t\t\t\t">4&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;63&nbsp;\t\t\t\t\t\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;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;70&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">TAC&nbsp;\t\t\t\t\t\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">149&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;67&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">TRIV &#40;ms&#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">84&nbsp;\t\t\t\t\t\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&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#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">11&#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;51&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">E mitral &#40;cm&#47;s&#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">82&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;98&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">TD &#40;ms&#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">137&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#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">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&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">A mitral &#40;cm&#47;s&#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">55&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&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">Rela&#231;&#227;o E&#47;A mitral&nbsp;\t\t\t\t\t\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;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;80&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">E&#8217; septal &#40;cm&#47;s&#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&#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
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#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">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;08&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">A&#8217; septal &#40;cm&#47;s&#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">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">9&#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">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;31&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">E&#8217; lateral &#40;cm&#47;s&#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&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;04&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">A&#8217; lateral &#40;cm&#47;s&#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
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                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;48&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">E&#8217; mitral m&#233;dio &#40;cm&#47;s&#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&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;04&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">A&#8217; mitral m&#233;dio &#40;cm&#47;s&#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">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">9&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92&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">Rela&#231;&#227;o E&#47;E&#8217; mitral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#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">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;13&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">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;78&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">D&nbsp;\t\t\t\t\t\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">49&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="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">Rela&#231;&#227;o S&#47;D&nbsp;\t\t\t\t\t\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;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#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">1&#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;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;01&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">VD basal &#40;mm&#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">33&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#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">33&#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">5&#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;60&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">TAPSE &#40;mm&#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">24&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;55&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">Velocidade S&#8217; VD &#40;cm&#47;s&#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&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#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">15&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86&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">FAC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#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">58&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;39&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">GLS VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;29&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#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">&#8208;28&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&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">LS &#193;pice do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;24&#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">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;25&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#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;19&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">LS M&#233;dio do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;31&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;30&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#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;16&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">LS Base do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;33&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Artigo Original
Avaliação ecocardiográfica na diabetes mellitus tipo 1
The use of echocardiography in type 1 diabetes
Thaís Rossoni Webera,
Autor para correspondência
thaisrossoni@yahoo.com

Autor para correspondência.
, Roberto Léo da Silvaa, Sandra Cossula, Marco Stephan Lofrano Alvesb, Simone Van der Sander Leea, Jefferson Luiz Brum Marquesc
a Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
b Universidade Federal do Paraná, Curitiba, PR, Brasil
c Universidade Federal de Santa Catarina, Florianópolis, PR, Brasil
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aumento de &#225;cidos graxos livres circulantes e de triacilglicer&#243;is&#44; estejam envolvidos na sua etiopatogenia&#46; Com o avan&#231;o tecnol&#243;gico&#44; diversos m&#233;todos diagn&#243;sticos&#44; em especial os de imagem&#44; tem sido utilizados para elucidar essa entidade tanto na DM1 quanto na DM2&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">O diagn&#243;stico precoce da cardiomiopatia diab&#233;tica &#233; clinicamente &#250;til&#44; uma vez que as les&#245;es iniciais podem ser revers&#237;veis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">4&#44;5</span></a> No entanto&#44; ainda &#233; uma condi&#231;&#227;o pouco reconhecida pelos cl&#237;nicos&#44; uma vez que pode exigir ferramentas mais sens&#237;veis para diagn&#243;stico e pela controv&#233;rsia dos resultados de estudos pr&#233;vios com diferentes m&#233;todos de avalia&#231;&#227;o e amostras heterog&#234;neas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da disfun&#231;&#227;o diast&#243;lica &#233; essencial para o entendimento da fun&#231;&#227;o card&#237;aca&#46; &#201; determinada simplificadamente pela altera&#231;&#227;o no relaxamento ventricular esquerdo e pelo aumento da rigidez mioc&#225;rdica&#46; &#201; evidenciada nas cardiomiopatias e est&#225; associada a progn&#243;stico mais desfavor&#225;vel&#44; incluindo mortalidade e hospitaliza&#231;&#227;o por insufici&#234;ncia card&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Considera&#8208;se a disfun&#231;&#227;o diast&#243;lica a altera&#231;&#227;o inicial da cardiomiopatia diab&#233;tica e ocorre em 27 a 69&#37; das pessoas assintom&#225;ticas com diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Um m&#233;todo sens&#237;vel para a avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica &#233; o Doppler tecidular&#44; que mede velocidades como e&#8217; &#40;velocidade diast&#243;lica precoce&#41;&#46; Esse &#233; um dos principais par&#226;metros na avalia&#231;&#227;o diast&#243;lica&#44; com maior reprodutibilidade e mais associado a desfechos cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Na DM1&#44; as velocidades e&#8217; e a rela&#231;&#227;o e&#8217;&#47;a&#8217; s&#227;o menores em rela&#231;&#227;o a controlos sadios&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Apesar de as diferen&#231;as nos par&#226;metros de avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica entre indiv&#237;duos com DM1 e controlos terem sido relatadas em v&#225;rios estudos pr&#233;vios&#44; no acompanhamento em longo prazo de indiv&#237;duos com DM1 n&#227;o houve maior incid&#234;ncia de disfun&#231;&#227;o diast&#243;lica naqueles sem hipertens&#227;o ou doen&#231;a coron&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> Discute&#8208;se a possibilidade de que o tratamento com reposi&#231;&#227;o de insulina normalize os desarranjos metab&#243;licos da hiperglicemia&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Com a progress&#227;o da cardiomiopatia diab&#233;tica&#44; admite&#8208;se o aumento do risco de desenvolvimento da insufici&#234;ncia card&#237;aca&#46; Especificamente em rela&#231;&#227;o &#224; DM1&#44; observou&#8208;se n&#227;o s&#243; a associa&#231;&#227;o entre DM1 e insufici&#234;ncia card&#237;aca como tamb&#233;m sua rela&#231;&#227;o com o controlo glic&#234;mico&#44; idade e dura&#231;&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Argumenta&#8208;se que a cardiomiopatia diab&#233;tica apresente diferentes fen&#243;tipos&#44; um deles representado pela disfun&#231;&#227;o diast&#243;lica e outro&#44; pela disfun&#231;&#227;o sist&#243;lica&#44; ambos determinando insufici&#234;ncia card&#237;aca&#44; e n&#227;o se tratando simplesmente de diferentes est&#225;gios evolutivos&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A incorpora&#231;&#227;o de novas t&#233;cnicas&#44; como o <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico na ecocardiografia&#44; tem por objetivo aumentar a sensibilidade diagn&#243;stica do m&#233;todo&#44; principalmente para disfun&#231;&#227;o mioc&#225;rdica subcl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">15&#44;16</span></a> O par&#226;metro mais utilizado &#233; o <span class="elsevierStyleItalic">strain</span> longitudinal global&#44; que se refere &#224; m&#233;dia do <span class="elsevierStyleItalic">strain</span> dos segmentos mioc&#225;rdicos no sentido longitudinal&#44; mais reprodut&#237;vel&#44; capaz de identificar disfun&#231;&#227;o subcl&#237;nica do ventr&#237;culo esquerdo &#40;VE&#41; e considerado um melhor preditor de risco do que a fra&#231;&#227;o de eje&#231;&#227;o do VE&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">17&#44;18</span></a> Demonstrou&#8208;se disfun&#231;&#227;o sist&#243;lica incipiente na DM1 atrav&#233;s de redu&#231;&#227;o do valor absoluto do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">19&#8211;23</span></a> Enquanto outros estudos associaram valores reduzidos de <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico ao controlo glic&#234;mico<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24&#44;25</span></a> ou &#224; presen&#231;a de complica&#231;&#245;es como nefropatia diab&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">26</span></a> Percebe&#8208;se com base na literatura resultados conflitantes em rela&#231;&#227;o &#224; disfun&#231;&#227;o sist&#243;lica subcl&#237;nica&#44; que poderia ser explicada em fun&#231;&#227;o da heterogeneidade da popula&#231;&#227;o estudada quanto &#224; presen&#231;a de comorbidades&#44; controlo glic&#234;mico&#44; tamanho da amostra&#44; idade&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">O presente estudo visa a identificar les&#245;es card&#237;acas precoces secund&#225;rias &#224; DM1 atrav&#233;s da ecocardiografia e atrav&#233;s de ecocardiografia bidimensional convencional com Doppler e avan&#231;ada com <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking&#46;</span></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; anal&#237;tico&#44; do tipo caso&#8208;controlo&#46; A amostra foi composta de 42 pacientes com diagn&#243;stico de DM1 e idade maior que 18 anos&#44; que se encontravam em seguimento ou apresentaram hist&#243;rico de consulta no ambulat&#243;rio de endocrinologia&#46; Foram inclu&#237;dos&#44; como grupo controlo&#44; 42 indiv&#237;duos sem diabetes e sem doen&#231;as cr&#244;nicas&#44; em sua maioria profissionais da sa&#250;de e funcion&#225;rios do mesmo hospital&#44; selecionados a partir de idade e sexo&#46; A sele&#231;&#227;o dos participantes iniciou em julho de 2018 e terminou em agosto de 2019&#44; consecutivamente respeitando os crit&#233;rios de inclus&#227;o e exclus&#227;o&#46; Para cumprir os requisitos &#233;ticos&#44; foi submetido e aprovado pelo comit&#234; de &#233;tica da institui&#231;&#227;o &#40;CAAE&#58; 24822114&#46;5&#46;0000&#46;0121&#41; conforme descrito na resolu&#231;&#227;o 466&#47;2012 do CNS&#46; Todos os participantes assinaram o termo de consentimento livre e esclarecido previamente a sua inclus&#227;o no estudo&#46; Foram 80 participantes que respeitaram os crit&#233;rios de exclus&#227;o&#58; &#40;1&#41; hipertens&#227;o arterial sist&#234;mica&#59; &#40;2&#41; suspeita ou diagn&#243;stico de doen&#231;a coron&#225;ria atrav&#233;s da hist&#243;ria cl&#237;nica &#40;sintomas ou hist&#243;rico de doen&#231;a coron&#225;ria&#41;&#59; &#40;3&#41; les&#227;o valvar significativa &#40;estenose ou insufici&#234;ncia valvar de grau maior do que ligeira&#41;&#59; &#40;4&#41; disfun&#231;&#227;o mioc&#225;rdica pr&#233;via ou diagn&#243;stico de cardiomiopatia&#59; &#40;5&#41; hist&#243;ria de radio ou quimioterapia&#59; &#40;6&#41; etilismo&#59; &#40;7&#41; janela ac&#250;stica limitada &#40;casos em que mais de dois segmentos mioc&#225;rdicos n&#227;o puderam ser visibilizados&#41;&#59; &#40;8&#41; recusa a participar do estudo&#46; Em cada grupo&#44; dois participantes foram exclu&#237;dos por janela ac&#250;stica limitada&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As vari&#225;veis cl&#237;nico&#8208;demogr&#225;ficas dos participantes foram obtidas atrav&#233;s de anamnese dos participantes&#46; Esta incluiu os seguintes dados&#58; idade&#44; idade do diagn&#243;stico de DM1&#44; epis&#243;dios de hipoglicemia ao m&#234;s&#44; hist&#243;ria de interna&#231;&#227;o por complica&#231;&#245;es referentes &#224; DM1&#44; dados antropom&#233;tricos&#44; h&#225;bitos de vida&#44; comorbidades&#44; complica&#231;&#245;es da DM1 e uso de medica&#231;&#245;es&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os seguintes exames laboratoriais foram coletados com jejum de 8 a 12 horas&#58; &#40;1&#41; hemoglobina &#40;g&#47;dl&#41;&#59; &#40;2&#41; glicemia de jejum &#40;mg&#47;dl&#41;&#59; &#40;3&#41; HbA1c &#40;&#37;&#41;&#59; &#40;4&#41; creatinina &#40;mg&#47;dl&#41;&#59; &#40;5&#41; microalbumin&#250;ria ou rela&#231;&#227;o albumina&#47;creatinina ou rela&#231;&#227;o prote&#237;na&#47;creatinina em amostra isolada de urina &#40;mg&#47;g&#41;&#59; &#40;6&#41; colesterol total &#40;mg&#47;dl&#41;&#59; &#40;7&#41; HDL &#40;mg&#47;dl&#41;&#59; &#40;8&#41; triglicer&#237;deos &#40;mg&#47;dl&#41;&#59; &#40;9&#41; LDL &#40;mg&#47;dl&#41;&#59; &#40;10&#41; TSH &#40;&#956;g&#41;&#46; O c&#225;lculo do <span class="elsevierStyleItalic">clearance</span> de creatinina foi realizado atrav&#233;s da equa&#231;&#227;o CKD&#8208;EPI&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">27</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica de todos os pacientes foi realizada por um &#250;nico ecocardiografista &#40;TRWS&#41;&#44; seguindo as recomenda&#231;&#245;es para quantifica&#231;&#227;o de c&#226;maras card&#237;acas pela Sociedade Americana de Ecocardiografia e Associa&#231;&#227;o Europeia de Imagem Cardiovascular&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">28</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">As imagens foram adquiridas em dec&#250;bito lateral esquerdo atrav&#233;s do equipamento GE S6 com transdutor 1&#44;5&#8211;3&#44;6<span class="elsevierStyleHsp" style=""></span>MHz&#44; utilizando as janelas ecocardiogr&#225;ficas&#58; paraesternal&#44; apical&#44; subcostal e supraesternal e armazenadas em m&#237;dia digital para futuras an&#225;lises e revis&#245;es&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Pelo corte longitudinal paraesternal&#44; obtiveram&#8208;se as seguintes medidas no fim da di&#225;stole ventricular&#58; espessura do septo interventricular &#40;SIV&#41; e da parede posterior do VE &#40;PPVE&#41;&#44; di&#226;metro diast&#243;lico do VE &#40;DDVE&#41; e di&#226;metro dos seios a&#243;rticos&#46; O c&#225;lculo da massa ventricular foi obtido atrav&#233;s da f&#243;rmula 0&#44;8 x 1&#44;04 x &#91;&#40;SIV &#43;DDVE &#43; PPVE&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a> &#8211; DDVE<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a>&#93; &#43; 0&#44;6<span class="elsevierStyleHsp" style=""></span>g&#44; utilizando o m&#233;todo linear com medidas realizadas ao ecocardiograma bidimensional&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o sist&#243;lica global do VE foi avaliada atrav&#233;s da fra&#231;&#227;o de eje&#231;&#227;o pelo m&#233;todo Simpson nas janelas apicais de 4 e 2 c&#226;maras e do <span class="elsevierStyleItalic">strain</span> longitudinal sist&#243;lico de pico pela ecocardiografia com <span class="elsevierStyleItalic">speckle tracking bidimensional &#40;2<span class="elsevierStyleHsp" style=""></span>DSTE&#41;</span> nas janelas apicais de 3&#44; 4 e 2 c&#226;maras&#44; para obten&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> global longitudinal do VE &#40;<span class="elsevierStyleItalic">GLSVE</span>&#41;&#46; Para a aquisi&#231;&#227;o das imagens&#44; aprimorou&#8208;se a qualidade da imagem&#44; com a frequ&#234;ncia de quadros maximizada &#40;60 a 90 quadros por segundo&#41;&#44; o encurtamento minimizado e o registro de pelo menos 3 batimentos&#44; durante apneia no fim da expira&#231;&#227;o&#46; Para an&#225;lise do <span class="elsevierStyleItalic">GLSVE</span>&#44; utilizou&#8208;se o <span class="elsevierStyleItalic">AFI</span> &#40;<span class="elsevierStyleItalic">automated funcion imaging</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">A an&#225;lise da fun&#231;&#227;o diast&#243;lica do VE incluiu as velocidades diast&#243;licas precoce &#40;E&#41; e tardia &#40;A&#41; do pico do fluxo transmitral aferidas na extremidade das c&#250;spides da valva mitral&#44; as velocidades diast&#243;licas precoce &#40;e&#8217;&#41; e tardia &#40;a&#8217;&#41; registradas ao Doppler tecidular no anel mitral septal e lateral&#59; rela&#231;&#227;o entre as velocidades E&#47;A do fluxo transvalvar mitral&#44; rela&#231;&#227;o entre as velocidades E&#47;valor m&#233;dio de e&#769; septal e lateral&#44; tempo de desacelera&#231;&#227;o da velocidade E&#44; intervalo de relaxamento isovolum&#233;trico&#44; ondas sist&#243;lica &#40;S&#41; e diast&#243;lica &#40;D&#41; do fluxo das veias pulmonares&#44; volume atrial esquerdo indexado pelo superf&#237;cie corp&#243;rea &#40;SC&#41; atrav&#233;s da m&#233;dia do volume no corte apical 4 c&#226;maras e no apical 2 c&#226;maras&#44; rela&#231;&#227;o das ondas S&#47;D do fluxo das veias pulmonares&#44; velocidade do jato de regurgita&#231;&#227;o tric&#250;spide&#44; se presente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As medidas do ventr&#237;culo direito &#40;VD&#41; foram obtidas no corte apical 4 c&#226;maras com foco no ventr&#237;culo direito&#46; A fun&#231;&#227;o sist&#243;lica do VD foi avaliada atrav&#233;s dos par&#226;metros&#58; excurs&#227;o sist&#243;lica do anel tric&#250;spide &#40;TAPSE&#41;&#44; varia&#231;&#227;o sist&#243;lica das &#225;reas do VD &#40;FAC&#41;&#44; velocidade m&#225;xima da onda S&#8217; ao Doppler tecidular e <span class="elsevierStyleItalic">strain</span> global longitudinal do VD por <span class="elsevierStyleItalic">speckle tracking</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#44; utilizando a m&#233;dia do <span class="elsevierStyleItalic">strain</span> longitudinal sist&#243;lico de pico dos tr&#234;s segmentos da parede livre do VD&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o diast&#243;lica do VD foi avaliada pela rela&#231;&#227;o E&#47;A&#44; tempo de desacelera&#231;&#227;o da onda E&#44; rela&#231;&#227;o E&#47;e&#769; e volume atrial direito indexado pela SC&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lise estat&#237;stica</span><p id="par0100" class="elsevierStylePara elsevierViewall">O tamanho da amostra foi estimado em 28 indiv&#237;duos em cada grupo com a finalidade de poder detectar uma diferen&#231;a de 1&#37; no <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico pelo m&#233;todo de <span class="elsevierStyleItalic">speckle tracking</span>&#44; quando comparados ao grupo controlo&#44; considerando um valor m&#233;dio de <span class="elsevierStyleItalic">strain</span> global longitudinal por <span class="elsevierStyleItalic">speckle tracking</span> &#8208;20&#44;3&#37; com desvio&#8208;padr&#227;o 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a> Foram utilizados para o c&#225;lculo amostral um n&#237;vel de signific&#226;ncia de 5&#37; e um n&#237;vel de poder estat&#237;stico de 95&#37;&#44; para teste bicaudado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Foi realizado o teste de Shapiro&#8208;Wilk para avaliar normalidade da distribui&#231;&#227;o de cada vari&#225;vel&#46; As vari&#225;veis cont&#237;nuas foram descritas como m&#233;dia com desvio&#8208;padr&#227;o&#44; sendo comparadas pelo teste <span class="elsevierStyleItalic">t</span> de Student&#44; quando com distribui&#231;&#227;o normal&#44; ou pelo teste de Mann&#8208;Whitney&#44; quando n&#227;o normalmente distribu&#237;das&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">As vari&#225;veis categ&#243;ricas foram descritas como percentagem ou frequ&#234;ncia e comparadas com o teste do qui&#8208;quadrado&#46; Os potenciais preditores de fun&#231;&#227;o ventricular foram avaliados calculando&#8208;se os coeficientes de correla&#231;&#227;o &#40;r<span class="elsevierStyleSup">2</span>&#41; atrav&#233;s do m&#233;todo de Pearson ou Spearman&#46; Todos os dados coletados foram armazenados e os c&#225;lculos estat&#237;sticos foram realizados no programa R para Windows&#44; vers&#227;o 3&#46;5&#46;3 &#40;<span class="elsevierStyleItalic">R Foundation</span>&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0115" class="elsevierStylePara elsevierViewall">A idade m&#233;dia do grupo DM1 foi de 32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 anos &#40;20 a 50 anos&#41; e do grupo controlo&#44; de 32&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 anos &#40;23 a 46 anos&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;89&#41;&#46; Em rela&#231;&#227;o ao g&#234;nero&#44; 55&#37; dos participantes de ambos os grupos eram mulheres&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Referente aos dados antropom&#233;tricos&#44; os dois grupos apresentaram &#237;ndice de massa corp&#243;rea m&#233;dio de 24&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; No grupo DM1&#44; 30&#37; dos pacientes estavam com sobrepeso e&#44; no grupo controlo&#44; 37&#44;5&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;77&#41;&#46; A obesidade foi observada em quatro indiv&#237;duos de cada grupo &#40;10&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No grupo DM1&#44; a idade m&#233;dia em que o diagn&#243;stico de DM1 ocorreu foi aos 15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;1 anos &#40;3 a 38 anos&#41; e dura&#231;&#227;o m&#233;dia do DM1 de 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3 anos &#40;2 a 38 anos&#41;&#46; Vinte por cento tinham retinopatia diab&#233;tica&#59; 12&#44;5&#37;&#44; ind&#237;cio de les&#227;o renal pelo DM1 pela presen&#231;a de microalbumin&#250;ria ou equivalente e 10&#37;&#44; neuropatia perif&#233;rica&#46; A ocorr&#234;ncia de hipoglicemias ao m&#234;s foi de 9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8 epis&#243;dios&#46; Nenhum paciente com DM1 foi internado no &#250;ltimo ano por complica&#231;&#245;es relacionadas ao diabetes&#46; A press&#227;o arterial sist&#243;lica m&#233;dia dos doentes com DM1 foi de 109&#44;7<span class="elsevierStyleHsp" style=""></span>mmHg e dos indiv&#237;duos no grupo controlo de 102&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e a press&#227;o diast&#243;lica m&#233;dia de 63&#44;7<span class="elsevierStyleHsp" style=""></span>mmHg dos doentes com DM1 e de 68&#44;6<span class="elsevierStyleHsp" style=""></span>mmHg nos controlos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quanto aos h&#225;bitos de vida&#44; 5&#37; dos pacientes com diabetes fumavam e 10&#37; eram ex&#8208;tabagistas&#59; no grupo controlo&#44; quase 8&#37; dos controlos fumavam&#44; os demais eram n&#227;o tabagistas&#46; A m&#233;dia de atividade f&#237;sica foi de 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>161 minutos por semana no grupo com DM1 e 141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>134 minutos por semana&#44; no grupo controlo &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos e os exames laboratoriais avaliados no estudo est&#227;o descritos na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A an&#225;lise ecocardiogr&#225;fica ao bidimensional demonstrou tamanhos semelhantes das c&#226;maras card&#237;acas&#44; sem diferen&#231;a no &#237;ndice de massa ventricular e na fun&#231;&#227;o sist&#243;lica atrav&#233;s do m&#233;todo Simpson&#46; N&#227;o houve diferen&#231;as nos &#237;ndices de desempenho card&#237;aco como volume sist&#243;lico e d&#233;bito card&#237;aco entre os grupos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O uso de Doppler tecidular para avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica do VE evidenciou redu&#231;&#227;o da velocidade diast&#243;lica precoce &#40;E&#8217; lateral&#41; e do valor m&#233;dio das velocidades diast&#243;licas precoces &#40;E&#8217; m&#233;dio&#41; e maior tempo de desacelera&#231;&#227;o da velocidade&#46; E no grupo DM1&#46; Outro par&#226;metro relacionado &#224; fun&#231;&#227;o diast&#243;lica do VE com diferen&#231;a entre os grupos&#44; menor no grupo com DM1&#44; foi a rela&#231;&#227;o S&#47;D&#46; &#205;ndices de fun&#231;&#227;o diast&#243;lica do VD como E&#8217; tric&#250;spide e rela&#231;&#227;o E&#8217;&#47;A&#8217; encontravam&#8208;se reduzidos no grupo DM1 em rela&#231;&#227;o ao controlo&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; aplica&#231;&#227;o do m&#233;todo de <span class="elsevierStyleItalic">speckle tracking</span> para quantifica&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico no VE&#44; n&#227;o se observaram diferen&#231;as no <span class="elsevierStyleItalic">strain</span> global longitudinal do VE entre os grupos&#46; No ventr&#237;culo direito&#44; o <span class="elsevierStyleItalic">strain</span> global longitudinal m&#233;dio foi similar em ambos os grupos&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Os demais dados ecocardiogr&#225;ficos coletados no estudo est&#227;o descritos na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">O par&#226;metro de fun&#231;&#227;o diast&#243;lica e&#8217; m&#233;dio apresentou correla&#231;&#227;o com os valores de HbA1c e tempo de dura&#231;&#227;o do DM &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8208;0&#44;33 e &#8208;0&#44;41&#59; respectivamente&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e o tempo de desacelera&#231;&#227;o&#44; com os valores de HbA1c &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;51&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; N&#227;o houve correla&#231;&#227;o entre os &#237;ndices de fun&#231;&#227;o sist&#243;lica e as vari&#225;veis cl&#237;nicas ou laboratoriais&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0165" class="elsevierStylePara elsevierViewall">O uso de novas t&#233;cnicas de imagem para diagn&#243;stico de cardiomiopatia diab&#233;tica tem propiciado a constru&#231;&#227;o de um maior conhecimento&#44; pela identifica&#231;&#227;o de les&#245;es mais precoces&#44; apesar de existirem resultados conflitantes&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">23&#44;26</span></a> possivelmente devido &#224; heterogeneidade da popula&#231;&#227;o estudada quanto aos aspectos demogr&#225;ficos e quanto &#224;s suas comorbidades&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A proposta deste trabalho foi estudar altera&#231;&#245;es card&#237;acas estruturais e funcionais relacionadas &#224; cardiomiopatia diab&#233;tica&#44; sem a interfer&#234;ncia de outras comorbidades que sabidamente causam les&#245;es card&#237;acas como por exemplo a hipertens&#227;o arterial sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">18</span></a> Tamb&#233;m n&#227;o houve internamentos por complica&#231;&#245;es de diabetes no &#250;ltimo ano&#44; o que poderia influenciar a avalia&#231;&#227;o card&#237;aca&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Os grupos selecionados eram compar&#225;veis&#44; uma vez que apresentaram caracter&#237;sticas gerais semelhantes&#58; idade m&#233;dia&#44; propor&#231;&#227;o de g&#234;nero masculino e feminino e &#237;ndice de massa corp&#243;rea&#59; condi&#231;&#245;es que determinam diferen&#231;as nos valores do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">No que se refere a complica&#231;&#245;es microvasculares&#44; a preval&#234;ncia de retinopatia foi menor do que a esperada para esta dura&#231;&#227;o m&#233;dia da DM1&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">31</span></a> Isso pode ser explicado pelo fato de a hipertens&#227;o arterial sist&#234;mica ser um crit&#233;rio de exclus&#227;o do estudo e considerando que a preval&#234;ncia de retinopatia est&#225; relacionada n&#227;o s&#243; &#224; dura&#231;&#227;o da DM1&#44; mas tamb&#233;m ao controlo glic&#234;mico e aos n&#237;veis press&#243;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">32</span></a> Independentemente&#44; n&#227;o se observa associa&#231;&#227;o da retinopatia diab&#233;tica com o desenvolvimento de doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">33</span></a> Em rela&#231;&#227;o &#224; les&#227;o renal&#44; definida pela evid&#234;ncia de protein&#250;ria&#44; houve preval&#234;ncia similar ao descrito na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">34</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica demonstrou redu&#231;&#227;o dos valores de E&#8217; mitral tanto da parede lateral quanto do valor m&#233;dio de E&#8217; entre septo e lateral&#44; que representa uma das vari&#225;veis mais robustas na an&#225;lise da fun&#231;&#227;o diast&#243;lica do VE&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a> Esse achado foi observado em outros trabalhos da literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a> N&#227;o houve casos de disfun&#231;&#227;o diast&#243;lica do VE &#40;utilizando algoritmo atual<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a>&#41; nem foi encontrado valor fora da normalidade para a faixa et&#225;ria dos indiv&#237;duos&#46; No entanto&#44; a redu&#231;&#227;o dos valores dessa vari&#225;vel no grupo DM1 sup&#245;e redu&#231;&#227;o da capacidade de relaxamento mioc&#225;rdico&#44; do mesmo modo que esses valores tamb&#233;m diminuem com o envelhecimento&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Houve diferen&#231;a entre outras duas vari&#225;veis utilizadas na an&#225;lise da fun&#231;&#227;o diast&#243;lica&#58; tempo de desacelera&#231;&#227;o da onda E e na rela&#231;&#227;o entre as ondas S &#40;sist&#243;lica&#41; e D &#40;diast&#243;lica&#41;&#46; O tempo de desacelera&#231;&#227;o da onda E est&#225; relacionado ao relaxamento e &#224; distensibilidade do VE&#44; um dos componentes determinantes da fun&#231;&#227;o diast&#243;lica do VE&#46; A velocidade da onda S est&#225; relacionada &#224; press&#227;o atrial esquerda&#44; contratilidade do &#225;trio esquerdo e contratilidade do ventr&#237;culo direito&#46; A velocidade da onda D &#233; influenciada principalmente pelo enchimento diast&#243;lico precoce do VE&#46; Diferen&#231;as nessas vari&#225;veis entre os grupos DM1 e controlo constituem mais um ind&#237;cio de disfun&#231;&#227;o diast&#243;lica do VE subcl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">7&#44;35</span></a> De fato&#44; n&#227;o houve diferen&#231;a entre volume atrial esquerdo indexado para a superf&#237;cie corp&#243;rea entre os grupos&#46; Este &#250;ltimo&#44; marcador da gravidade de disfun&#231;&#227;o diast&#243;lica&#44; reflete o efeito cumulativo das press&#245;es de enchimento com o tempo&#46; <a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">36&#44;37</span></a> Levanta&#8208;se a hip&#243;tese de que outras vari&#225;veis como o <span class="elsevierStyleItalic">strain</span> atrial esquerdo&#44; muito associado &#224; press&#227;o atrial esquerda e em estudo nas miocardiopatias&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a> poderiam contribuir na avalia&#231;&#227;o desses pacientes&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">A m&#233;dia do <span class="elsevierStyleItalic">strain</span> longitudinal global do VE encontrado no grupo controlo &#40;&#8208;21&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#41; foi semelhante aos valores de normalidade &#40;&#8208;21&#44;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#41; apresentados na literatura para o mesmo <span class="elsevierStyleItalic">software</span> utilizado&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">28&#44;39</span></a> Outro achado condizente com a literatura foi a diferen&#231;a do valor do <span class="elsevierStyleItalic">strain</span> longitudinal global do VE relacionado ao g&#234;nero&#44; sendo mais negativo no sexo feminino em compara&#231;&#227;o ao masculino&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29&#44;39</span></a> N&#227;o houve diferen&#231;a no valor de <span class="elsevierStyleItalic">strain</span> global longitudinal entre os grupos tanto do VE quanto do VD&#46; No que se refere ao VE&#44; a aus&#234;ncia de diferen&#231;as na fun&#231;&#227;o sist&#243;lica ventricular pode estar relacionada &#224; aus&#234;ncia de hipertens&#227;o e outras comorbidades como hist&#243;ria de doen&#231;a coron&#225;ria na popula&#231;&#227;o estudada&#44; o que pode ser um fator de confus&#227;o nos estudos pr&#233;vios&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">8&#44;26</span></a> Tamb&#233;m deve&#8208;se considerar que poucos pacientes com DM1 apresentaram n&#237;veis glic&#234;micos elevados&#44; o que poderia reduzir a manifesta&#231;&#227;o de cardiomiopatia diab&#233;tica nos pacientes com DM1&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Observou&#8208;se&#44; no entanto&#44; maior <span class="elsevierStyleItalic">strain</span> longitudinal de pico sist&#243;lico no segmento basal do VD em rela&#231;&#227;o ao grupo controlo&#46; Esse achado n&#227;o foi demonstrado nos demais segmentos do ventr&#237;culo direito nem houve diferen&#231;a na m&#233;dia do <span class="elsevierStyleItalic">strain</span> mioc&#225;rdico do ventr&#237;culo direito &#40;<span class="elsevierStyleItalic">strain</span> global longitudinal do VD&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Referente ao ventr&#237;culo direito&#44; demonstrou&#8208;se redu&#231;&#227;o das ondas E&#8217; tric&#250;spide&#44; o que infere redu&#231;&#227;o da capacidade de relaxamento mioc&#225;rdica do ventr&#237;culo direito&#44; par&#226;metro utilizado na avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica do ventr&#237;culo direito&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limita&#231;&#245;es</span><p id="par0210" class="elsevierStylePara elsevierViewall">Todos os exames ecocardiogr&#225;ficos foram realizados uma &#250;nica vez&#46; Desse modo&#44; n&#227;o foi poss&#237;vel avaliar a variabilidade intra e interoperadores&#46; Contudo&#44; descreve&#8208;se na literatura boa reprodutibilidade do m&#233;todo&#44; permitindo aplica&#231;&#227;o desses resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Apesar de o tamanho da amostra ter sido adequado para se demonstrar a diferen&#231;a desejada tanto na fun&#231;&#227;o sist&#243;lica quanto diast&#243;lica&#44; a avalia&#231;&#227;o de um maior n&#250;mero de pacientes seria interessante para confirmar esses resultados&#46; Al&#233;m disso&#44; n&#227;o houve seguimento dos pacientes para que se possa inferir qual a evolu&#231;&#227;o cl&#237;nica e ecocardiogr&#225;fica&#44; sobretudo dos par&#226;metros estudados&#46; Apesar de previamente determinadas em m&#233;todo da pesquisa&#44; foram realizadas compara&#231;&#245;es m&#250;ltiplas&#44; aumentando a probabilidade de algumas diferen&#231;as encontradas serem ao acaso&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclus&#227;o</span><p id="par0220" class="elsevierStylePara elsevierViewall">Mesmo comparando pessoas assintom&#225;ticas com DM1&#44; observa&#8208;se diferen&#231;a nos par&#226;metros de avalia&#231;&#227;o da fun&#231;&#227;o diast&#243;lica biventricular em rela&#231;&#227;o aos controlos&#44; o que pode denotar uma redu&#231;&#227;o sutil da fun&#231;&#227;o card&#237;aca nesses pacientes e poss&#237;vel cardiomiopatia diab&#233;tica incipiente&#46; No entanto&#44; quanto &#224; fun&#231;&#227;o sist&#243;lica de ambos os ventr&#237;culos&#44; n&#227;o houve diferen&#231;a entre os dois grupos utilizando <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking</span>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiamento</span><p id="par0225" class="elsevierStylePara elsevierViewall">Ger&#234;ncia de Ensino e Pesquisa do Hospital Universit&#225;rio Professor Polydoro Ernani de S&#227;o Thiago&#44; Universidade Federal de Santa Catarina&#44; Brasil&#44; atrav&#233;s de financiamento pr&#243;prio &#40;GEP &#8208; protocolo 029&#41;&#44; para custear os exames laboratoriais dos indiv&#237;duos do grupo controlo&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflitos de interesse</span><p id="par0230" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesses&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diabetes <span class="elsevierStyleItalic">mellitu</span>s tipo 1 &#40;DM1&#41; &#233; uma doen&#231;a cr&#244;nica com pico de incid&#234;ncia na adolesc&#234;ncia&#44; com grande impacto na morbimortalidade&#44; principalmente cardiovascular&#46; A cardiomiopatia diab&#233;tica caracteriza&#8208;se por les&#245;es estruturais e funcionais na aus&#234;ncia de outras doen&#231;as&#59; e est&#225; implicada na progress&#227;o para insufici&#234;ncia card&#237;aca&#46; A ecocardiografia tem propiciado a identifica&#231;&#227;o de les&#245;es card&#237;acas precoces&#44; apesar de resultados controversos na DM1&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar altera&#231;&#245;es card&#237;acas em indiv&#237;duos com DM1 em compara&#231;&#227;o ao controlo &#40;pessoas sem comorbidades&#41; atrav&#233;s de ecocardiografia bidimensional convencional com Doppler e avan&#231;ada com <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking&#46;</span></p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo caso&#8208;controlo com 40 pacientes com DM1 de 20 a 50 anos&#44; assintom&#225;ticos&#44; normotensos&#44; e 40 controlos&#46; Avalia&#231;&#227;o ecocardiogr&#225;fica em modo bidimensional foi realizada para medida de espessura mioc&#225;rdica e das c&#226;maras card&#237;acas&#44; uso de Doppler tecidular na an&#225;lise diast&#243;lica e <span class="elsevierStyleItalic">strain</span> por <span class="elsevierStyleItalic">speckle tracking</span> para quantificar a fun&#231;&#227;o sist&#243;lica ventricular&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Idade m&#233;dia foi de 33 anos em ambos os grupos&#44; com dura&#231;&#227;o m&#233;dia da DM1 de 18 anos&#44; 20&#37; dos pacientes com diabetes apresentaram retinopatia diab&#233;tica&#59; 12&#44;5&#37;&#44; les&#227;o renal&#59; e 10&#37;&#44; neuropatia perif&#233;rica&#46; Houve diferen&#231;as na fun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo &#40;E&#8217; lateral&#44; E&#8217; m&#233;dio e rela&#231;&#227;o S&#47;D&#41; e do ventr&#237;culo direito &#40;E&#8217; tric&#250;spide e rela&#231;&#227;o E&#8217;&#47;A&#8217; tric&#250;spide&#41;&#46; O valor m&#233;dio do <span class="elsevierStyleItalic">strain</span> global longitudinal foi &#8208;21&#44;7&#37; &#40;&#43;&#8208; 2&#44;3&#41; no grupo DM1 e &#8208;21&#44;0&#37; &#40;&#43;&#8208;2&#44;0&#41; no controlo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;21&#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 avalia&#231;&#227;o ecocardiogr&#225;fica identificou redu&#231;&#227;o nos &#237;ndices de fun&#231;&#227;o diast&#243;lica na DM1 em compara&#231;&#227;o ao controlo&#44; que pode constituir a les&#227;o card&#237;aca inicial na diabetes&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Type 1 diabetes &#40;T1D&#41; is a chronic disease with peak incidence in adolescence&#59; it has a major impact on morbidity and mortality&#44; especially cardiovascular&#46; Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure&#46; Echocardiography has led to the identification of early cardiac lesions&#44; despite controversial results in the literature in patients with T1D&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two&#8208;dimensional Doppler and advanced speckle tracking echocardiography&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">This is a case&#8208;control study with 40 asymptomatic&#44; normotensive T1D patients aged 20 to 50 years and 40 healthy subjects&#46; Two&#8208;dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers&#46; Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">The mean age was 33 years in both groups&#44; with an average T1D duration of 18 years&#59; 20&#37; of patients with T1D had diabetic retinopathy&#59; 12&#46;5&#37; kidney injury&#59; and 10&#37; peripheral neuropathy&#46; There were differences in the left ventricular diastolic function parameters &#40;lateral E&#8217;&#44; middle E&#8217; and S&#47;D ratio&#41; and right ventricle &#40;tricuspid E and tricuspid E&#8217;&#47;A&#8217; ratio&#41;&#46; The mean value of the global longitudinal strain was &#8208;21&#46;7&#37; &#40;&#43;&#8208; 2&#46;3&#41; in the T1D group and &#8208;21&#46;0&#37; &#40;&#43;&#8208;2&#46;0&#41; in the control group &#40;p&#61;0&#46;21&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Echocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group&#44; which may be the initial cardiac lesion in diabetes&#46;</p></span>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise do <span class="elsevierStyleItalic">strain</span> longitudinal global do ventr&#237;culo esquerdo pela 2 DSTE&#46; C&#225;lculo do <span class="elsevierStyleItalic">strain</span> longitudinal global pela 2 DSTE&#44; atrav&#233;s de AFI&#46; Na &#64257;gura&#44; o <span class="elsevierStyleItalic">strain</span> global longitudinal do ventr&#237;culo esquerdo obtido foi de &#8208;23&#44;5&#37; em paciente com diabetes mellitus tipo 1&#46;</p>"
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise do strain longitudinal global do ventr&#237;culo direito pela 2DSTE&#46; Strain longitudinal global do ventr&#237;culo direito&#44; obtido pela m&#233;dia do strain dos tr&#234;s segmentos da parede livre do ventr&#237;culo direito em paciente com diabetes mellitus tipo 1&#46; Neste caso&#44; estimado em &#8208;30&#44;6&#37;&#46; Observa&#231;&#227;o&#58; o valor demonstrado na&#160;&#64257;gura considerou os segmentos da parede septal para c&#225;lculo do strain&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Valores apresentados como m&#233;dia e respetivo desvio padr&#227;o &#40;&#177;&#41; ou porcentagem absoluta&#46; Atividade F&#237;sica descrita em minutos por semana &#40;autodeclarada&#41;&#46; HDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>lipoprote&#237;na de alta densidade&#59; LDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>lipoprote&#237;nas de baixa densidade&#59; TSH<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>horm&#244;nio tireoestimulante&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo DM1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sexo &#40;feminino&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Atividade F&#237;sica &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>134&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hipotireodismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">101&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">104&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Evid&#234;ncia de protein&#250;ria</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Colesterol total &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">161&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">189&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24&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">VAE&#47;SC &#40;ml&#47;m<span class="elsevierStyleSup">2</span>&#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">23&#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">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&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">IM&#47;SC &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#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&#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">10&#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">59&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#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;83&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">FEVE &#40;Teichholz&#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">71&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40&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">FEVE &#40;Simpson&#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">71&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;79&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">GLS VE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;21&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">&#8208;21&#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">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;21&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">Volume sist&#243;lico &#40;ml&#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">61&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#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">65&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#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">0&#44;26&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">D&#233;bito card&#237;aco &#40;L&#47;min&#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&#44;51&nbsp;\t\t\t\t\t\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;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;63&nbsp;\t\t\t\t\t\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;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;70&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">TAC&nbsp;\t\t\t\t\t\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">149&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;67&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">TRIV &#40;ms&#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">84&nbsp;\t\t\t\t\t\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&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#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">11&#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;51&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">E mitral &#40;cm&#47;s&#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">82&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;98&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">TD &#40;ms&#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">137&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#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">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&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">A mitral &#40;cm&#47;s&#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">55&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Rela&#231;&#227;o E&#47;A mitral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#8217; septal &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">A&#8217; septal &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#8217; lateral &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">A&#8217; lateral &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#8217; mitral m&#233;dio &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">A&#8217; mitral m&#233;dio &#40;cm&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Rela&#231;&#227;o E&#47;E&#8217; mitral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Rela&#231;&#227;o S&#47;D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">VD basal &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#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">33&#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">5&#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;60&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">TAPSE &#40;mm&#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">24&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;55&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">Velocidade S&#8217; VD &#40;cm&#47;s&#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&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#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">15&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86&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">FAC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#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">58&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;39&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">GLS VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;29&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#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">&#8208;28&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&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">LS &#193;pice do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;24&#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">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;25&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#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;19&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">LS M&#233;dio do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;31&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;30&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&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">LS Base do VD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;33&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;30&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&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">E tric&#250;spide &#40;cm&#47;s&#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">61&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;70&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">E&#8217; tric&#250;spide &#40;cm&#47;s&#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
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                  \t\t\t\t">15&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&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">A&#8217; tric&#250;spide VD &#40;cm&#47;s&#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">14&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86&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">Rela&#231;&#227;o E&#47;E&#8217; tric&#250;spide&nbsp;\t\t\t\t\t\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&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;67&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
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Informação do artigo
ISSN: 08702551
Idioma original: Português
DOI:10.1016/j.repc.2020.11.012
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