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admiss&#227;o&#44; a apresenta&#231;&#227;o cl&#237;nica permite estratificar os doentes quanto ao risco de morte a curto prazo&#46; Deste modo&#44; os doentes que se apresentem em choque ou hipotensos s&#227;o considerados de alto risco&#59; os restantes dividem-se em risco interm&#233;dio &#40;caso haja evid&#234;ncia de disfun&#231;&#227;o do ventr&#237;culo direito e&#47;ou les&#227;o mioc&#225;rdica&#41; ou em baixo risco &#40;sem choque&#44; hipotens&#227;o&#44; disfun&#231;&#227;o ventricular direita ou marcadores de les&#227;o mioc&#225;rdica&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; A anticoagula&#231;&#227;o deve ser institu&#237;da <span class="elsevierStyleItalic">ab initio</span>&#44; ainda durante o processo diagn&#243;stico&#44; caso se determine uma probabilidade alta ou interm&#233;dia de TEP&#44; enquanto a terap&#234;utica fibrinol&#237;tica deve ser reservada para doentes de alto risco &#40;classe <span class="elsevierStyleSmallCaps">I</span>&#41; e para alguns doentes de risco interm&#233;dio &#40;classe <span class="elsevierStyleSmallCaps">II</span>b&#41;&#44; na aus&#234;ncia de contraindica&#231;&#245;es<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; A fibrin&#243;lise provou conduzir a uma diminui&#231;&#227;o mais r&#225;pida dos defeitos de perfus&#227;o e da disfun&#231;&#227;o ventricular direita&#44; mas n&#227;o da mortalidade em doentes de risco interm&#233;dio<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Embora se admita que na maioria dos doentes ocorra resolu&#231;&#227;o do quadro de oclus&#227;o arterial pulmonar em cerca de 6-12 meses&#44; o desenvolvimento de hipertens&#227;o pulmonar tromboemb&#243;lica cr&#243;nica &#40;HPTEC&#41; parece ser uma extens&#227;o da hist&#243;ria natural ap&#243;s um epis&#243;dio agudo de TEP<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Contudo&#44; n&#227;o h&#225; consenso quanto &#224; sua incid&#234;ncia&#44; que varia entre 0&#44;6-7&#44;0&#37;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7-11</span></a>&#46; A associa&#231;&#227;o entre TEP e HPTEC pode chegar a apresentar taxas de mortalidade de 70-90&#37;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; mas se corretamente identificados&#44; a maioria dos doentes pode ser tratada recorrendo &#224; endarterectomia pulmonar<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; O <span class="elsevierStyleItalic">continuum</span> fisiopatol&#243;gico entre as duas entidades parece ser influenciado n&#227;o s&#243; pela incorreta resolu&#231;&#227;o do quadro agudo obstrutivo e endoteliza&#231;&#227;o de trombos que ocluem ou estreitam as art&#233;rias pulmonares&#44; mas tamb&#233;m por altera&#231;&#245;es histol&#243;gicas da microvasculatura pulmonar<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Foram descritos alguns fatores de risco que favorecem a evolu&#231;&#227;o de um epis&#243;dio de TEP agudo para a cronicidade&#44; tais como a idade &#40;mais jovem<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> ou mais avan&#231;ada<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#41;&#44; a hist&#243;ria de TEP pr&#233;via<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; a presen&#231;a de um defeito de perfus&#227;o extenso<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; a apresenta&#231;&#227;o idiop&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; a press&#227;o sist&#243;lica da art&#233;ria pulmonar &#40;PSAP&#41; &#224; admiss&#227;o superior ou igual a 50<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;16</span></a> e as dimens&#245;es do trombo inicial<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; No entanto&#44; o crit&#233;rio de sele&#231;&#227;o dos doentes nestes trabalhos foi pouco espec&#237;fico relativamente &#224; estratifica&#231;&#227;o de risco da TEP &#224; admiss&#227;o<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O objetivo deste estudo &#233; a determina&#231;&#227;o de fatores de risco de desenvolvimento de hipertens&#227;o pulmonar &#40;HTP&#41; numa popula&#231;&#227;o de doentes que apresentou um epis&#243;dio agudo de TEP de risco interm&#233;dio a elevado&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Colheita de dados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Precedeu-se a uma an&#225;lise retrospetiva de uma base de dados prospetivamente contru&#237;da de 213 doentes&#44; consecutivamente internados na unidade de cuidados intensivos coron&#225;rios &#40;UCIC&#41; dos Hospitais da Universidade de Coimbra &#40;HUC&#41; com o diagn&#243;stico de TEP de risco interm&#233;dio a elevado&#44; entre 13 de maio de 2000 e 15 de outubro de 2010&#46; O diagn&#243;stico foi confirmado por angiografia tomogr&#225;fica assistida por computador &#40;angio-TC&#41; ou cintigrafia de ventila&#231;&#227;o&#47;perfus&#227;o&#46; Os dados cl&#237;nicos dos doentes recolhidos &#224; data de admiss&#227;o permitiram determinar <span class="elsevierStyleItalic">a posteriori</span> a estratifica&#231;&#227;o do risco&#44; aplicando as normas de orienta&#231;&#227;o cl&#237;nicas atuais<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Os dados foram complementados por an&#225;lise individual dos processos cl&#237;nicos dos doentes&#46; A decis&#227;o para a realiza&#231;&#227;o de tratamento fibrinol&#237;tico com alteplase &#40;Actylise<span class="elsevierStyleSup">&#174;</span>&#44; Boheringer Ingelheim&#44; Alemanha&#41; esteve a cargo do m&#233;dico assistente&#46; A maioria dos doentes recebeu tratamento fibrinol&#237;tico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>183&#41;&#46; Inicialmente&#44; os doentes foram anticoagulados com heparina n&#227;o fracionada&#44; &#224; qual se associou anticoagula&#231;&#227;o oral com varfarina&#46; Foi institu&#237;do suporte inotr&#243;pico&#44; vasopressor e ventilat&#243;rio de acordo com a avalia&#231;&#227;o cl&#237;nica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foram considerados os seguintes fatores de risco para TEP&#58; idade avan&#231;ada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>80 anos&#41;&#44; obesidade&#44; varizes dos membros inferiores&#44; imobilidade recente&#44; trombofilia conhecida&#44; tromboembolismo venoso pr&#233;vio&#44; gravidez&#44; toma de contracetivos orais&#44; doen&#231;a neopl&#225;sica conhecida&#44; insufici&#234;ncia card&#237;aca&#44; traumatismo <span class="elsevierStyleItalic">major</span> ou cirurgia <span class="elsevierStyleItalic">major</span> recentes&#46; Foram tamb&#233;m recolhidas outras vari&#225;veis demogr&#225;ficas&#44; cl&#237;nicas&#44; laboratoriais e imagiol&#243;gicas&#46; Foram considerados obesos os doentes com valores de &#237;ndice de massa corporal &#40;IMC&#41; &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">&#8722;2</span>&#46; Realizou-se um seguimento cl&#237;nico com uma dura&#231;&#227;o mediana de tr&#234;s anos para 187 dos 196 doentes que tiveram alta &#40;95&#44;4&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ecocardiografia transtor&#225;cica</span><p id="par0035" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de HTP foi considerado para os doentes com PSAP &#8805;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mmHg&#44; estimada em ecocardiografia transtor&#225;cica atrav&#233;s da an&#225;lise do gradiente de press&#227;o de regurgita&#231;&#227;o tric&#250;spide&#44; pela f&#243;rmula PSAP &#61;<span class="elsevierStyleHsp" style=""></span>4 &#40;V<span class="elsevierStyleInf">TR</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#43; press&#227;o venosa central&#46; A press&#227;o venosa central foi estimada de acordo com a an&#225;lise da cin&#233;tica da veia cava inferior<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; O tempo mediano at&#233; &#224; realiza&#231;&#227;o da ecocardiografia foi de 22 &#40;13-38&#41; meses&#44; com um m&#225;ximo de 137 meses&#46; Foram consideradas v&#225;lidas as ecocardiografias executadas no hospital&#44; no m&#237;nimo tr&#234;s meses ap&#243;s a alta do doente&#59; dos 187 doentes&#44; 121 &#40;56&#44;8&#37; do total&#41; cumpriram estes requisitos&#46; Nos indiv&#237;duos que realizaram m&#250;ltiplas ecocardiografias durante o seguimento cl&#237;nico&#44; somente a mais recente foi considerada&#46; Este processo permitiu distribuir os doentes por dois grupos&#58; grupo A &#40;PSAP &#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; com 106 doentes &#40;87&#44;6&#37;&#41; e grupo B &#40;PSAP &#8805;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; com 15 doentes &#40;12&#44;4&#37;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lise estat&#237;stica</span><p id="par0040" class="elsevierStylePara elsevierViewall">As vari&#225;veis cont&#237;nuas com distribui&#231;&#227;o normal foram expressas em m&#233;dia &#177; desvio padr&#227;o&#44; enquanto as vari&#225;veis com distribui&#231;&#227;o n&#227;o normal foram avaliadas pelo teste de Kolmogorov-Smirnov e expressas em mediana &#40;intervalo interquartil&#41;&#46; As vari&#225;veis categ&#243;ricas foram apresentadas sob a forma de valores absolutos e percentagens&#46; As compara&#231;&#245;es entre grupos foram feitas utilizando o teste t de Student&#44; U de Mann-Whitney ou X-quadrado&#44; de acordo com o tipo de vari&#225;vel&#46; Em todos os testes foram considerados significativos os valores de p inferiores a 0&#44;05&#46; Os par&#226;metros que&#44; em an&#225;lise univariada&#44; demonstraram associa&#231;&#227;o com o desenvolvimento de HTP durante o per&#237;odo de seguimento cl&#237;nico com um valor p inferior a 0&#44;05 foram inclu&#237;dos num modelo de an&#225;lise multivariada&#46; Os melhores pontos de corte para cada uma dessas var&#225;veis foram determinados utilizando curvas <span class="elsevierStyleItalic">receiver-operating characteristics</span> &#40;ROC&#41;&#46; Foi utilizado&#44; para an&#225;lise estat&#237;stica&#44; o <span class="elsevierStyleItalic">software</span> SPSS 20&#46;0 &#40;Chicago&#44; Illinois&#44; EUA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Dados demogr&#225;ficos e cl&#237;nicos</span><p id="par0045" class="elsevierStylePara elsevierViewall">No total&#44; 213 doentes foram inclu&#237;dos neste estudo &#40;61&#44;5&#37; mulheres&#41;&#44; com uma idade m&#233;dia de 61&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;1 anos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46; A maioria dos doentes &#40;90&#44;6&#37;&#41; apresentava pelo menos um fator de risco para TEP&#44; enquanto 20 casos &#40;9&#44;4&#37;&#41; foram considerados idiop&#225;ticos&#59; esta frequ&#234;ncia n&#227;o se mostrou significativamente diferente entre os doentes com ou sem hipertens&#227;o pulmonar ap&#243;s a TEP &#40;13&#44;2 <span class="elsevierStyleItalic">versus</span> 6&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;692&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Dos fatores de risco para TEP &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#44; observaram-se diferen&#231;as significativas entre os dois grupos relativamente &#224; idade e &#224; utiliza&#231;&#227;o de contracetivos orais&#46; No grupo A&#44; menos de 3&#37; dos doentes tinham&#44; &#224; data de diagn&#243;stico da TEP&#44; idade superior a 79 anos&#44; contrastando a frequ&#234;ncia relativa de 53&#44;3&#37; determinada nos indiv&#237;duos do grupo B&#46; A compara&#231;&#227;o das m&#233;dias de idades permitiu determinar que os doentes do grupo B eram mais idosos do que os doentes do grupo A &#40;70&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;8 <span class="elsevierStyleItalic">versus</span> 54&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;3 anos&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#224; data do diagn&#243;stico de TEP &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46; No grupo B&#44; nenhum dos doentes estava medicado com contracetivos orais &#224; admiss&#227;o&#44; ao passo que esta caracter&#237;stica foi identificada em cerca de um quarto dos doentes do grupo A&#46; Os restantes fatores de risco apresentaram-se em frequ&#234;ncia semelhante nos dois grupos&#46; No grupo B encontrou-se uma maior propor&#231;&#227;o de indiv&#237;duos do sexo masculino &#40;60&#44;0 <span class="elsevierStyleItalic">versus</span> 31&#44;1&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">O grupo B apresentava um IMC mais elevado &#40;31&#44;3 &#91;27&#44;3-37&#44;8&#93; <span class="elsevierStyleItalic">versus</span> 27&#44;6 &#91;25&#44;0-30&#44;8&#93; kg&#46;m<span class="elsevierStyleSup">&#8722;2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41; e consequentemente uma maior incid&#234;ncia de obesidade &#40;66&#44;7&#37; <span class="elsevierStyleItalic">versus</span> 29&#44;63&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41; comparativamente ao grupo A &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3 e</a><a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; &#192; admiss&#227;o&#44; os doentes do grupo A registaram uma press&#227;o arterial sist&#243;lica significativamente mais baixa do que os doentes do grupo B &#40;113 &#91;110-140&#93; <span class="elsevierStyleItalic">versus</span> 140 &#91;120-152&#93; mmHg&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46; Uma minoria dos doentes &#40;5&#44;6&#37;&#41; apresentou-se hipotenso &#224; admiss&#227;o&#44; pelo que foram diagnosticados com TEP de risco elevado&#59; destes&#44; 50&#37; faleceram antes da realiza&#231;&#227;o da ecocardiografia de seguimento cl&#237;nico &#40;tr&#234;s durante o internamento e tr&#234;s ap&#243;s a alta hospitalar&#41;&#46; Nenhum dos seis sobreviventes de TEP de risco elevado desenvolveu hipertens&#227;o pulmonar durante o seguimento cl&#237;nico&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o dos dados da gasimetria arterial n&#227;o detetou diferen&#231;as entre os dois grupos&#46; Contudo&#44; os doentes do grupo B apresentavam valores de hemoglobina superiores aos do grupo A &#40;15&#44;1 <span class="elsevierStyleItalic">versus</span> 13&#44;3<span class="elsevierStyleHsp" style=""></span>g&#46;dL<span class="elsevierStyleSup">&#8722;1</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46; N&#227;o se demonstraram diferen&#231;as significativas entre os dois grupos quer relativamente aos achados imagiol&#243;gicos &#224; admiss&#227;o quer quanto &#224; abordagem terap&#234;utica&#44; nomeadamente relativamente &#224; utiliza&#231;&#227;o de fibrinol&#237;ticos &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">Tabelas 3 e 4</a>&#41;&#46; Durante o per&#237;odo de seguimento cl&#237;nico&#44; as recidivas de TEP nos dois grupos foram semelhantes&#44; com sete casos &#40;6&#44;6&#37;&#41; no grupo A e um caso &#40;6&#44;7&#37;&#41; no grupo B&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise multivari&#225;vel</span><p id="par0065" class="elsevierStylePara elsevierViewall">Inclu&#237;ram-se na an&#225;lise multivari&#225;vel os seguintes par&#226;metros&#58; idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; g&#233;nero &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41;&#44; IMC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#44; press&#227;o arterial sist&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; hemoglobina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; e utiliza&#231;&#227;o de contracetivos orais &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41;&#46; Foram preditores de desenvolvimento de HTP a idade e o IMC&#46; Dessa forma&#44; calculou-se um <span class="elsevierStyleItalic">hazard ratio</span> de 1&#44;09 &#40;intervalo de confian&#231;a &#91;IC&#93; 95&#37; 1&#44;02-1&#44;20&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; por cada ano de idade e de 1&#44;19 &#40;IC95&#37; 1&#44;04-1&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41; por cada unidade de kg&#46;m<span class="elsevierStyleSup">&#8722;2</span> de IMC&#46; A <a class="elsevierStyleCrossRef" href="#fig0020">Figura 4</a> reflete a diferen&#231;a significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; entre a PSAP dos doentes com idade inferior a 68 anos e IMC inferior a 30<span class="elsevierStyleHsp" style=""></span>kg&#46;m<span class="elsevierStyleSup">&#8722;2</span>&#40;31&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6<span class="elsevierStyleHsp" style=""></span>mmHg&#41; e a dos doentes com idade igual ou superior a 68 anos e IMC igual ou superior a 30<span class="elsevierStyleHsp" style=""></span>kg&#46;m<span class="elsevierStyleSup">&#8722;2</span> &#40;48&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;0<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Neste trabalho&#44; identific&#225;mos fatores de risco para o desenvolvimento de HTP ap&#243;s TEP de risco interm&#233;dio a elevado numa coorte de 213 doentes maioritariamente submetidos a tratamento fibrinol&#237;tico&#46; Em 12&#44;4&#37; dos 121 doentes que realizaram ecocardiografia foi detetada HTP&#44; tendo sido identificados como fatores de risco para o seu desenvolvimento a idade avan&#231;ada e a obesidade&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A incid&#234;ncia de HTP na nossa s&#233;rie &#233; superior a outras publicadas na literatura&#46; Em 2004&#44; Pengo et al<span class="elsevierStyleItalic">&#46;</span> relata uma incid&#234;ncia significativamente inferior &#40;1&#44;0&#37; aos seis meses e 3&#44;8&#37; aos dois anos&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; no entanto&#44; tal como Kline et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> &#40;7&#44;0&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> e Klok et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> &#40;0&#44;6&#37;&#41;&#44; n&#227;o apresenta dados relativamente &#224; estratifica&#231;&#227;o do risco de mortalidade da TEP &#224; admiss&#227;o&#46; O mesmo se aplica ao trabalho de Becattini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; que apresenta uma menor incid&#234;ncia de HTP p&#243;s-TEP &#40;0&#44;8&#37; a tr&#234;s anos&#41;&#46; Esta incid&#234;ncia mais baixa pode dever-se ao facto de terem sido realizadas ecocardiografias apenas a doentes que manifestassem dispneia persistente no seguimento cl&#237;nico&#46; No entanto&#44; os doentes com HTP podem permanecer assintom&#225;ticos durante meses ou anos&#44; habitualmente apresentando-se numa fase tardia da doen&#231;a<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Dado que por vezes o &#250;nico sinal evidente &#233; a acentua&#231;&#227;o do componente pulmonar do segundo som card&#237;aco&#44; a exclusiva sele&#231;&#227;o de doentes sintom&#225;ticos para a realiza&#231;&#227;o da ecocardiografia poder&#225; ter subestimado a sua verdadeira incid&#234;ncia&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o&#44; a idade demonstrou ser um fator preditor de desenvolvimento de HTP ap&#243;s uma TEP&#44; em concord&#226;ncia com os achados de Ribeiro et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; que constataram que uma idade superior a 70 anos &#233; um fator de risco para o desenvolvimento de HPTEC&#46; Paradoxalmente&#44; Pengo et al<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleItalic">&#46;</span> descreve uma maior incid&#234;ncia de HPTEC nos doentes mais jovens &#224; data de diagn&#243;stico de TEP&#46; Esta maior incid&#234;ncia de HTP nos doentes idosos pode tanto dever-se a uma maior incid&#234;ncia de fen&#243;menos tromboemb&#243;licos de repeti&#231;&#227;o&#44; que s&#227;o mais frequentes nesta idade<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Deve salientar-se que como a maioria dos estudos foi feito apenas com recurso a ecocardiografia&#44; n&#227;o podem ser exclu&#237;das outras formas de HTP que poder&#227;o contribuir para a eleva&#231;&#227;o da press&#227;o pulmonar&#44; como a disfun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Ser&#227;o necess&#225;rios mais dados para determinar o verdadeiro impacto da idade como fator de risco para a progress&#227;o para HPTEC&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A obesidade foi tamb&#233;m identificada como fator de risco para o desenvolvimento de HTP p&#243;s-TEP&#46; Verific&#225;mos que cada incremento de uma unidade no IMC aumentava em cerca de 20&#37; a probabilidade de desenvolver HTP ap&#243;s uma TEP&#46; Este dado &#233; particularmente interessante&#44; pois n&#227;o se encontra anteriormente descrito na literatura&#46; Algumas explica&#231;&#245;es podem ser avan&#231;adas para explicar esta associa&#231;&#227;o&#46; A dislipid&#233;mia&#44; fortemente relacionada com a obesidade<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; poder&#225; condicionar a remodela&#231;&#227;o da microvasculatura pulmonar a jusante da obstru&#231;&#227;o&#44; que se encontra associada n&#227;o s&#243; &#224; HPTEC como a outras causas de HTP<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; De facto&#44; por cada incremento de uma unidade no IMC&#44; verifica-se eleva&#231;&#227;o da PSAP de 0&#44;1-0&#44;4<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; A obesidade pode contribuir de outras formas para o desenvolvimento de HTP&#44; quer pelo aumento do d&#233;bito card&#237;aco<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> quer pela comorbilidade com outras causas bem conhecidas de HTP&#44; nomeadamente a apneia obstrutiva do sono ou a insufici&#234;ncia card&#237;aca diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o&#44; a hist&#243;ria pr&#233;via de TEP&#44; a presen&#231;a de uma TEP idiop&#225;tica ou de um defeito de perfus&#227;o extenso&#44; descritos como fatores de risco para o desenvolvimento de HPTEC<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; n&#227;o apresentaram diferen&#231;as estatisticamente significativas entre os dois grupos em estudo &#40;assumindo que a presen&#231;a de trombos nos ramos principais revela uma obstru&#231;&#227;o anatomicamente extensa&#41;&#46; Analogamente&#44; n&#227;o se comprovou a rela&#231;&#227;o com as dimens&#245;es do trombo inicial<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> e tamb&#233;m n&#227;o foi poss&#237;vel demonstrar diferen&#231;as significativas na PSAP &#224; admiss&#227;o relativamente &#224; incid&#234;ncia de HPTEC&#44; tal como descrevem outros autores<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Contudo&#44; a aus&#234;ncia destas associa&#231;&#245;es deve ser interpretada &#224; luz da gravidade cl&#237;nica da grande maioria dos doentes aquando do diagn&#243;stico&#44; reflexo da deposi&#231;&#227;o de um trombo de dimens&#245;es suficientemente elevadas para obstruir os ramos <span class="elsevierStyleItalic">major</span> da &#225;rvore vascular pulmonar e provocar um extenso defeito de perfus&#227;o&#46; Este quadro condicionou um maior recurso &#224; fibrin&#243;lise&#44; permitindo uma mais r&#225;pida resolu&#231;&#227;o do quadro obstrutivo quando comparado ao tratamento apenas com heparina<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Note-se a elevada taxa de doentes fibrinolisados no nosso estudo &#40;86&#37;&#41; quando em compara&#231;&#227;o com outras s&#233;ries publicadas na literatura &#40;7-41&#37;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#8211;11</span></a><span class="elsevierStyleSup">&#41;</span>&#41;&#46; H&#225;&#44; no entanto&#44; dados preliminares que sugerem que a fibrin&#243;lise poder&#225; estar eventualmente associada a menor incid&#234;ncia de HPTEC<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A HPTEC &#233; a &#250;nica forma cur&#225;vel de hipertens&#227;o pulmonar&#44; tornando fulcral o seu diagn&#243;stico preciso e atempado&#46; Este pode permitir a realiza&#231;&#227;o da endarterectomia pulmonar&#44; uma t&#233;cnica cir&#250;rgica complexa mas que permite a recupera&#231;&#227;o total da capacidade funcional dos doentes e com uma mortalidade inferior a 5&#37; nos centros de refer&#234;ncia<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;23</span></a>&#46; Para a minoria de doentes n&#227;o oper&#225;veis&#44; os f&#225;rmacos vasodilatadores pulmonares podem ter indica&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; O riociguat&#44; um estimulador da guanilato ciclase sol&#250;vel&#44; demonstrou recentemente num ensaio cl&#237;nico multic&#234;ntrico &#40;CHEST-1&#41; que melhora a capacidade funcional de doentes com HPTEC n&#227;o-oper&#225;vel&#44; avaliada atrav&#233;s do teste de marcha dos seis minutos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Pelo facto de ter um desenho retrospetivo&#44; este trabalho tem v&#225;rias limita&#231;&#245;es&#46; Consideramos que a principal limita&#231;&#227;o &#233; o facto de o diagn&#243;stico de HTP ter sido realizado por ecocardiografia e n&#227;o por cateterismo direito&#44; o m&#233;todo <span class="elsevierStyleItalic">gold-standard</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Deste modo&#44; al&#233;m da possibilidade de alguns doentes serem falsos-positivos ou falsos negativos&#44; n&#227;o foi tamb&#233;m poss&#237;vel identificar outras causas concomitantes de HTP&#44; como disfun&#231;&#227;o ventricular esquerda&#46; Salientamos que um diagn&#243;stico de HPTEC apenas poder&#225; ser confirmado ou exclu&#237;do com seguran&#231;a recorrendo &#224; cintigrafia de ventila&#231;&#227;o-perfus&#227;o &#40;ou &#224; angiografia pulmonar&#41; em associa&#231;&#227;o com um cateterismo direito&#46; A utiliza&#231;&#227;o da angio-TC nesta indica&#231;&#227;o est&#225; associada a uma taxa que pode chegar aos 50&#37; de falsos negativos<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Desde modo&#44; preferimos utilizar a nomenclatura HTP ap&#243;s-TEP&#44; pois o diagn&#243;stico de HPTEC &#40;Grupo 4&#41; exige as referidas t&#233;cnicas diagn&#243;sticas&#46; Outra limita&#231;&#227;o consiste na aus&#234;ncia de <span class="elsevierStyleItalic">follow-up</span> ecocardiogr&#225;fico de parte da popula&#231;&#227;o em estudo&#44; que pode induzir um vi&#233;s na preval&#234;ncia de HTP&#46; Apenas a realiza&#231;&#227;o de um protocolo prospetivo poder&#225; mitigar esta importante limita&#231;&#227;o&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Consideramos&#44; no entanto&#44; que a descri&#231;&#227;o pela primeira vez da preval&#234;ncia de HTP p&#243;s-TEP de risco interm&#233;dio a grave pode despertar a aten&#231;&#227;o para este problema&#46; Uma preval&#234;ncia de cerca de 10&#37; a tr&#234;s anos poder&#225; motivar o seguimento cl&#237;nico cuidadoso destes doentes&#44; nomeadamente daqueles mais idosos e&#47;ou mais obesos&#46; Naturalmente&#44; a realiza&#231;&#227;o do diagn&#243;stico diferencial com outras causas de HTP mant&#233;m-se cr&#237;tica para a correta sele&#231;&#227;o destes doentes para interven&#231;&#245;es cir&#250;rgicas ou m&#233;dicas&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclus&#245;es</span><p id="par0110" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o&#44; a preval&#234;ncia de HTP ap&#243;s um epis&#243;dio agudo de TEP de risco interm&#233;dio a elevado foi de 12&#37;&#46; Foram fatores preditores para o seu desenvolvimento a idade avan&#231;ada e a obesidade&#46; Os nossos dados sugerem que doentes mais idosos e&#47;ou mais obesos devem ser sujeitos a uma cuidadosa vigil&#226;ncia cl&#237;nica e ecocardiogr&#225;fica ap&#243;s uma TEP&#44; pois este poder&#225; possibilitar a identifica&#231;&#227;o precoce de HTP&#44; eventualmente permitindo atuar em fases mais iniciais da doen&#231;a&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Responsabilidades &#233;ticas</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Prote&#231;&#227;o de pessoas e animais</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidencialidade dos dados</span><p id="par0120" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos de seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Direito &#224; 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            0 => "Hipertens&#227;o pulmonar tromboemb&#243;lica cr&#243;nica"
            1 => "Tromboembolia-pulmonar"
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            3 => "&#205;ndice de massa corporal"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A tromboembolia pulmonar &#40;TEP&#41; &#233; uma emerg&#234;ncia cardiovascular comum que&#44; juntamente com a hipertens&#227;o pulmonar tromboemb&#243;lica cr&#243;nica &#40;HPTEC&#41;&#44; se associa a alta mortalidade e morbilidade&#46; N&#227;o h&#225; ainda consenso quanto &#224; consecutividade destas patologias&#46; Este estudo pretende determinar a incid&#234;ncia e fatores de risco para o desenvolvimento de hipertens&#227;o pulmonar &#40;HTP&#41; ap&#243;s uma TEP de risco interm&#233;dio a elevado&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estud&#225;mos retrospetivamente 213 doentes com TEP de risco interm&#233;dio a elevado&#44; entre 2000-2010&#44; e comparamos dados demogr&#225;ficos&#44; cl&#237;nicos&#44; laboratoriais e imagiol&#243;gicos entre os doentes que manifestaram HTP durante o seguimento cl&#237;nico &#40;doentes que&#44; pelo menos tr&#234;s meses ap&#243;s a alta&#44; mantivessem press&#245;es sist&#243;licas na art&#233;ria pulmonar acima de 40<span class="elsevierStyleHsp" style=""></span>mmHg&#44; estimadas por ecocardiografia&#41; com os doentes que mantiveram press&#245;es normais&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Identificou-se HTP ap&#243;s a TEP em 12&#44;4&#37; dos doentes&#46; Foram fatores preditores para o desenvolvimento desta complica&#231;&#227;o a idade &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; 1&#44;09 &#91;intervalo de confian&#231;a &#123;IC&#125; 95&#37; 1&#44;02-1&#44;20&#93; por ano de idade&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; e o &#237;ndice de massa corporal &#40;HR 1&#44;19 &#91;IC 95&#37; 1&#44;04-1&#44;36&#93; por kg<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">&#8722;2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A HTP ap&#243;s uma TEP foi uma complica&#231;&#227;o relativamente comum na nossa s&#233;rie de doentes com um epis&#243;dio agudo de TEP de risco interm&#233;dio a elevado&#46; Identificamos como fatores preditores do desenvolvimento desta complica&#231;&#227;o a idade avan&#231;ada e a obesidade&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pulmonary embolism &#40;PE&#41; is a common cardiovascular emergency that&#44; when combined with chronic thromboembolic pulmonary hypertension &#40;PH&#41;&#44; is associated with high mortality and morbidity&#46; We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010&#46; Clinical data at admission were collected and the incidence of PH as assessed by echocardiography &#40;estimated pulmonary systolic artery pressure over 40 mmHg&#41; was determined&#46; Multivariate analysis was used to determine predictors of development of PH&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">PH was detected in 12&#46;4&#37; of patients after a mean follow-up of three years&#46; Only age &#40;hazard ratio &#91;HR&#93; 1&#46;09&#44; 95&#37; confidence interval &#91;CI&#93; 1&#46;02-1&#46;20 per year&#59; p&#61;0&#46;012&#41; and body mass index &#40;HR 1&#46;19&#44; 95&#37; CI 1&#46;04-1&#46;36&#41; per kg&#47;m2&#44; p&#61;0&#46;013&#41; emerged as independent predictors of the development of this complication during follow-up&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">PH after PE was a relatively common complication in our series&#46; We identified advanced age and increased body mass index as predisposing factors&#46;</p>"
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                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade &#8805;<span class="elsevierStyleHsp" style=""></span>80 anos&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;106 &#40;2&#44;83&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;15 &#40;53&#44;33&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trombofilia&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;106 &#40;1&#44;89&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varizes dos membros inferiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#47;106 &#40;27&#44;36&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;15 &#40;20&#44;00&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;760&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TEV pr&#233;vio&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#47;106 &#40;27&#44;36&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;15 &#40;13&#44;33&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gravidez&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;106 &#40;0&#44;94&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contracetivos orais&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#47;106 &#40;25&#44;47&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a neopl&#225;sica&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;106 &#40;10&#44;38&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insufici&#234;ncia card&#237;aca&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;106 &#40;7&#44;55&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traumatismo <span class="elsevierStyleItalic">major</span>&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;106 &#40;11&#44;32&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;15 &#40;6&#44;66&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirurgia <span class="elsevierStyleItalic">major</span>&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;106 &#40;18&#44;87&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;15 &#40;6&#44;66&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idiop&#225;tica&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;106 &#40;13&#44;21&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;15 &#40;6&#44;66&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;691&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab433117.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Frequ&#234;ncia dos fatores de risco para TEP nos dois grupos em estudo</p>"
        ]
      ]
      5 => array:7 [
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">FC&#58; frequ&#234;ncia card&#237;aca&#59; HTA&#58; hipertens&#227;o arterial&#59; IMC&#58; &#237;ndice de massa corporal&#59; TA&#58; tens&#227;o arterial&#59; TEP&#58; tromboembolia pulmonar&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo B &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>68 anos&#44; n &#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">29&#47;106 &#40;27&#44;36&#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">11&#47;15 &#40;73&#44;33&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">G&#233;nero</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&#44; n &#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">33&#47;106 &#40;31&#44;13&#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&#47;15 &#40;60&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&#44; n &#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">73&#47;106 &#40;68&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;15 &#40;40&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;25 &#40;27&#44;27-37&#44;72&#41;&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#8805;<span class="elsevierStyleHsp" style=""></span>30 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; n&nbsp;\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">24&#47;81 &#40;29&#44;63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;12 &#40;66&#44;67&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FC&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#44;00 &#40;80&#44;00-104&#44;50&#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">97 &#40;85&#44;00-101&#44;50&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TA sist&#243;lica</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#44;50 &#40;110&#44;00-140&#44;00&#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">140&#44;00 &#40;120&#44;00-152&#44;00&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#47;106 &#40;5&#44;66&#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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#44;00&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>135<span class="elsevierStyleHsp" style=""></span>mmHg&#44; n&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#47;106 &#40;30&#44;19&#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">10&#47;15 &#40;66&#44;67&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TEP&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#47;106 &#40;4&#44;72&#37;&#41;&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\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#44;00&#37;&#41;&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">1&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#47;15 &#40;73&#44;33&#37;&#41;&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\ttop\n
                  \t\t\t\t">0&#44;058&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pCO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#44;55 &#40;28&#44;00-37&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span>&#44; mEq&#47;L&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"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&#44; g&#47;dL&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"><span class="elsevierStyleHsp" style=""></span>Troponina <span class="elsevierStyleSmallCaps">I</span>&#44; ng&#47;mL&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;15 &#40;0&#44;05-0&#44;46&#41;&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">0&#44;36 &#40;0&#44;04-1&#44;75&#41;&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;538&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D-D&#237;meros&#44; &#956;g&#47;mL&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">8&#44;00 &#40;5&#44;60-23&#44;10&#41;&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="char" valign="\n
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                  \t\t\t\t">0&#44;073&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"><span class="elsevierStyleHsp" style=""></span>Fibrinog&#233;nio&#44; mg&#47;dL&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">3&#44;75 &#40;3&#44;00-4&#44;65&#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">3&#44;40 &#40;2&#44;85-4&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;649&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"><span class="elsevierStyleHsp" style=""></span>INR&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">1&#44;17 &#40;1&#44;07-1&#44;30&#41;&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">1&#44;25 &#40;1&#44;10-1&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;224&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  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;153&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"><span class="elsevierStyleHsp" style=""></span>PSAP m&#233;dia&#44; mmHg&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"><span class="elsevierStyleHsp" style=""></span>PSAP &#8805;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mmHg&#44; n &#40;&#37;&#41;&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"><span class="elsevierStyleHsp" style=""></span>PSAP &#8805;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mmHg&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#47;74 &#40;45&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#47;10 &#40;70&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;365&nbsp;\t\t\t\t\t\t\n
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