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<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" dtd-version="3.0" article-type="research-article" xml:lang="pt">
  <front>
    <journal-meta>
      <journal-id journal-id-type="nlm-ta">Arq Bras Cardiol</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">WLsXC5JZjntMC7d8SV9wqTf</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2014000200031</article-id>
      <article-id pub-id-type="publisher-id" specific-use="previous-pid">S0066-782X2013005030243</article-id>
      <article-id pub-id-type="other">00031</article-id>
      <article-id pub-id-type="doi">10.5935/abc.20130243</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos Originais</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title xml:lang="pt">Resposta Hipertr&#243;fica da Associa&#231;&#227;o de Horm&#244;nio Tireoidiano
               e de Exerc&#237;cio F&#237;sico no Cora&#231;&#227;o de Ratos</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Souza</surname>
            <given-names>Fernanda Rodrigues de</given-names>
          </name>
          <xref ref-type="corresp" rid="c01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Resende</surname>
            <given-names>Elmiro Santos</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Lopes</surname>
            <given-names>Leandro</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Gon&#231;alves</surname>
            <given-names>Alexandre</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Chagas</surname>
            <given-names>Rafaella</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Fidale</surname>
            <given-names>Thiago</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rodrigues</surname>
            <given-names>Poliana</given-names>
          </name>
        </contrib>
      </contrib-group>
      <aff>
        <institution content-type="orgname">Universidade Federal de Uberl&#226;ndia</institution>
        <addr-line>
          <named-content content-type="city">Uberl&#226;ndia</named-content>
          <named-content content-type="state">MG</named-content>
        </addr-line>
        <country>Brasil</country>
        <institution content-type="original">UFU - Universidade Federal de Uberl&#226;ndia, Uberl&#226;ndia, MG -
               Brasil</institution>
      </aff>
      <author-notes>
        <corresp id="c01"><bold>Correspond&#234;ncia:</bold> Fernanda Rodrigues de Souza, Rua Cachoeira Dourada,
               115, Granada. CEP 38540-410, Uberl&#226;ndia, MG - Brasil. E-mail:
                  <email>nandaeduca@yahoo.com.br</email>
				</corresp>
        <fn fn-type="conflict">
          <p><bold>Potencial Conflito de Interesses</bold> Declaro n&#227;o haver conflito de
                  interesses pertinentes.</p>
        </fn>
        <fn fn-type="other">
          <p><bold>Vincula&#231;&#227;o Acad&#234;mica</bold> Este artigo &#233; parte de disserta&#231;&#227;o de Mestrado
                  de Fernanda Rodrigues de Souza pela Universidade Federal de Uberl&#226;ndia (UFU).</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub">
        <day>21</day>
        <month>12</month>
        <year>2013</year>
      </pub-date>
      <pub-date pub-type="collection">
        <month>03</month>
        <year>2014</year>
      </pub-date>
      <volume>102</volume>
      <issue>02</issue>
      <fpage>187</fpage>
      <lpage>191</lpage>
      <history>
        <date date-type="received">
          <day>06</day>
          <month>06</month>
          <year>2013</year>
        </date>
        <date date-type="rev-recd">
          <day>13</day>
          <month>09</month>
          <year>2013</year>
        </date>
        <date date-type="accepted">
          <day>26</day>
          <month>09</month>
          <year>2013</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
          <license-p>This is an Open Access article distributed under the terms of the Creative
                  Commons Attribution Non-Commercial License which permits unrestricted
                  non-commercial use, distribution, and reproduction in any medium, provided the
                  original work is properly cited. </license-p>
        </license>
      </permissions>
      <abstract xml:lang="pt">
        <sec>
          <title>Fundamento:</title>
          <p> A hipertrofia card&#237;aca constitui um dos componentes do remodelamento card&#237;aco e
                  ocorre em resposta a aumento da atividade ou da sobrecarga funcional do cora&#231;&#227;o.
               </p>
        </sec>
        <sec>
          <title>Objetivo:</title>
          <p> Avaliar a resposta hipertr&#243;fica da associa&#231;&#227;o do horm&#244;nio tireoidiano e do
                  exerc&#237;cio f&#237;sico no cora&#231;&#227;o de ratos. </p>
        </sec>
        <sec>
          <title>M&#233;todo:</title>
          <p> Foram utilizados 37 ratos da linhagem Wistar, machos, adultos, distribu&#237;dos
                  aleatoriamente em quatro grupos: controle, horm&#244;nio (HT), exerc&#237;cio (E), horm&#244;nio
                  tireoidiano e exerc&#237;cio (H + E). O grupo horm&#244;nio recebeu diariamente levotiroxina
                  s&#243;dica por gavagem, na dose de 20 &#956;g de horm&#244;nio tireoidiano/100 g de peso
                  corporal; o grupo exerc&#237;cio realizou nata&#231;&#227;o cinco vezes por semana, com peso
                  adicional correspondente a 20% do peso corporal, durante seis semanas; no grupo H
                  + E foram aplicados simultaneamente os tratamentos dos grupos HT e E. A estat&#237;sica
                  utilizada foi a an&#225;lise de vari&#226;ncia complementada, quando necess&#225;rio, pelo teste
                  de Tukey e o teste de correla&#231;&#227;o de Pearson. </p>
        </sec>
        <sec>
          <title>Resultados:</title>
          <p> O T4 foi mais elevado nos grupos HT e H + E. O peso total do cora&#231;&#227;o foi maior
                  nos grupos que receberam horm&#244;nio tireoidiano, e o peso ventricular esquerdo foi
                  maior no grupo HT. O di&#226;metro transversal dos cardiomi&#243;citos aumentou nos grupos
                  HT, E e H + E. A porcentagem de col&#225;geno foi maior nos grupos E e H + E. A an&#225;lise
                  da correla&#231;&#227;o entre as vari&#225;veis apresentou distintas respostas. </p>
        </sec>
        <sec>
          <title>Conclus&#227;o:</title>
          <p> A associa&#231;&#227;o do horm&#244;nio tireoidiano com exerc&#237;cio f&#237;sico de elevada intensidade
                  produziu hipertrofia card&#237;aca e gerou um padr&#227;o hipertr&#243;fico n&#227;o correlacionado
                  diretamente ao grau de fibrose.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="pt">
        <kwd>Horm&#244;nios Tire&#243;ideos</kwd>
        <kwd>Exerc&#237;cio</kwd>
        <kwd>Ratos</kwd>
        <kwd>Cora&#231;&#227;o</kwd>
        <kwd>Hipertireoidismo</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="2"/>
        <equation-count count="0"/>
        <ref-count count="19"/>
        <page-count count="5"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <sec sec-type="intro">
      <title>Introdu&#231;&#227;o</title>
      <p>O horm&#244;nio tireoidiano e o exerc&#237;cio f&#237;sico produzem eleva&#231;&#227;o geral do metabolismo basal
            e, como consequ&#234;ncia, ocorre maior consumo de oxig&#234;nio pelos tecidos. Essa demanda
            aumentada &#233; suprida, em parte, pela eleva&#231;&#227;o da frequ&#234;ncia card&#237;aca, da press&#227;o
            arterial, tanto sist&#243;lica quanto diast&#243;lica, e do d&#233;bito card&#237;aco<xref ref-type="bibr" rid="B01">1</xref>.</p>
      <p>Testes cl&#237;nicos e experimentais sugerem que as adapta&#231;&#245;es card&#237;acas s&#227;o resultados de
            efeitos diretos do horm&#244;nio sobre o cora&#231;&#227;o e os vasos, e indiretamente decorrem da
            eleva&#231;&#227;o s&#233;rica de catecolaminas<xref ref-type="bibr" rid="B02">2</xref>.</p>
      <p>A hipertrofia card&#237;aca &#233; um dos componentes do remodelamento card&#237;aco que implica
            modifica&#231;&#245;es da estrutura geom&#233;trica, da composi&#231;&#227;o bioqu&#237;mica, da gera&#231;&#227;o e condu&#231;&#227;o
            el&#233;trica, do volume das c&#233;lulas musculares, da organiza&#231;&#227;o da matriz de col&#225;geno e dos
            vasos sangu&#237;neos. Ela decorre de altera&#231;&#245;es de ordem gen&#233;tica, humoral e molecular que
            podem surgir espontaneamente ou ser induzidas por mecanismos estressores de diferentes
            tipos e com formas variadas de a&#231;&#227;o<xref ref-type="bibr" rid="B03">3</xref>.</p>
      <p>O treinamento f&#237;sico, dentro de limites razo&#225;veis, induz hipertrofia card&#237;aca do tipo
            fisiol&#243;gico, produzindo adapta&#231;&#245;es que melhoram o desempenho do sistema cardiovascular,
            permitindo ao cora&#231;&#227;o suportar aumentos da demanda durante o exerc&#237;cio. A hipertrofia
            card&#237;aca &#233; acompanhada por incremento do tempo de enchimento ventricular e da fra&#231;&#227;o de
            eje&#231;&#227;o do ventr&#237;culo esquerdo, com consequente diminui&#231;&#227;o da frequ&#234;ncia card&#237;aca de
               repouso<xref ref-type="bibr" rid="B04">4</xref>
				<sup>,</sup>
				<xref ref-type="bibr" rid="B05">5</xref>.</p>
      <p>As principais diferen&#231;as que determinam o padr&#227;o de hipertrofia card&#237;aca s&#227;o o tipo e a
            dura&#231;&#227;o do est&#237;mulo que o cora&#231;&#227;o recebe. Em situa&#231;&#245;es nas quais os atletas recebem
            sobrecargas de press&#227;o apenas durante a atividade f&#237;sica, a hipertrofia card&#237;aca &#233;, em
            geral, fisiol&#243;gica. Diferentemente, em situa&#231;&#245;es patol&#243;gicas o cora&#231;&#227;o est&#225; exposto
            continuamente &#224; sobrecarga funcional que ocorre por um longo tempo, determinando
            hipertrofia patol&#243;gica<xref ref-type="bibr" rid="B06">6</xref>. </p>
      <p>O horm&#244;nio tireoidiano em excesso pode promover esses dois padr&#245;es de hipertrofia
            descritos (hipertrofia card&#237;aca mista). Essa resposta parece decorrer, em parte, da
            sobrecarga de volume em fun&#231;&#227;o do aumento do retorno venoso produzido pelo HT e tamb&#233;m
            dos efeitos diretos do horm&#244;nio<xref ref-type="bibr" rid="B07">7</xref>
				<sup>,</sup>
				<xref ref-type="bibr" rid="B08">8</xref>.</p>
    </sec>
    <sec>
      <title>Objetivo</title>
      <p>Avaliar a resposta hipertr&#243;fica da associa&#231;&#227;o do horm&#244;nio tireoidiano e do exerc&#237;cio
            f&#237;sico no cora&#231;&#227;o de ratos.</p>
    </sec>
    <sec>
      <title>M&#233;todo</title>
      <p>Os procedimentos foram realizados ap&#243;s aprova&#231;&#227;o do protocolo de pesquisa pelo comit&#234; de
            &#233;tica na utiliza&#231;&#227;o de animais da institui&#231;&#227;o, sob os n&#250;meros 077/10. O estudo conduzido
            foi do tipo experimental.</p>
      <p>Foram utilizados 37 ratos da linhagem Wistar, machos, adultos, com peso de
            aproximadamente 250 g, provenientes do laborat&#243;rio de experimenta&#231;&#227;o animal (Cebea-UFU).
            As condi&#231;&#245;es ambientais para todos os grupos foram semelhantes, no que se refere &#224;
            temperatura, umidade relativa do ar, n&#237;vel de ru&#237;do e luminosidade, de conformidade com
            o ritmo circadiano. Os ratos foram alimentados com ra&#231;&#227;o e &#225;gua <italic>ad
               libitum</italic>.</p>
      <p>Os ratos foram pesados e distribu&#237;dos aleatoriamente em quatro grupos identificados
            assim: controle (C), oito animais; horm&#244;nio (HT), 10 animais; exerc&#237;cio (E), nove
            animais; horm&#244;nio e exerc&#237;cio (H + E), 10 animais. Depois de distribu&#237;dos, os animais
            passaram por um per&#237;odo de adapta&#231;&#227;o de 15 dias no laborat&#243;rio antes do in&#237;cio do
            experimento. </p>
      <p>O tipo de exerc&#237;cio utilizado foi de car&#225;ter anaer&#243;bio. Para o treinamento, foi
            utilizado um vidro com 250 mm de di&#226;metro<xref ref-type="bibr" rid="B09">9</xref>. A
            altura da coluna de &#225;gua no vidro correspondeu a 150% do comprimento corporal do rato. A
            temperatura da &#225;gua foi mantida entre 30-32&#176;C por ser considerada termicamente neutra em
            rela&#231;&#227;o &#224; temperatura corporal do animal<xref ref-type="bibr" rid="B10">10</xref>. A
            carga utilizada no treinamento foi correspondente a 20% do peso corporal do rato, por
            ser considerada uma sobrecarga que aumenta a concentra&#231;&#227;o de lactato<xref ref-type="bibr" rid="B11">11</xref>. A referida carga de trabalho consistiu em blocos
            de chumbo fixados em um colete na regi&#227;o anterior do tronco dos ratos. A carga foi
            reajustada semanalmente, conforme a varia&#231;&#227;o do peso dos animais.</p>
      <p>O per&#237;odo de treinamento foi iniciado ap&#243;s sete dias de adapta&#231;&#227;o ao meio l&#237;quido. O
            treinamento foi realizado em seis semanas e consistiu em cinco sess&#245;es semanais de
            nata&#231;&#227;o limitadas pela exaust&#227;o. </p>
      <p>O horm&#244;nio foi administrado por meio de sondagem orog&#225;strica realizada uma vez ao dia,
            durante seis semanas. A dose de horm&#244;nio tireoidiano foi de 20 &#181;g/100 g de peso corporal
            de uma suspens&#227;o de T4 a 0,1% que foi obtida a partir de 10 comprimidos de 100 &#181;g de T4
            dilu&#237;dos em 10 ml de &#225;gua destilada<xref ref-type="bibr" rid="B12">12</xref>.</p>
      <p>Ap&#243;s as seis semanas de experimento, os ratos foram sacrificados sob anestesia,
            procedendo-se &#224; abertura do t&#243;rax para a coleta do sangue por pun&#231;&#227;o direta card&#237;aca e
            retirada do cora&#231;&#227;o. A confirma&#231;&#227;o da exposi&#231;&#227;o a n&#237;veis elevados do horm&#244;nio
            tireoidiano foi realizada pela dosagem s&#233;rica de T3 e T4 pelo m&#233;todo ELISA.</p>
      <p>O cora&#231;&#227;o foi pesado e formolizado, processo que teve a dura&#231;&#227;o de 24 horas. Ap&#243;s a
            formoliza&#231;&#227;o, foram retirados os &#225;trios e separados os ventr&#237;culos para pesagem; a
            seguir, o material foi encaminhado para processamento histol&#243;gico.</p>
      <p>Para analisar os di&#226;metros transversais dos cardiomi&#243;citos, as l&#226;minas foram coradas com
            eosina/hematoxilina, e, para quantificar o col&#225;geno, as l&#226;minas foram coradas com
            picross&#237;rius. Foram obtidos cinco cortes de cada ventr&#237;culo e medidos os menores
            di&#226;metros de cinco c&#233;lulas (com n&#250;cleo vis&#237;vel) em cinco campos diferentes. Para as
            medidas foram realizadas an&#225;lises em imagens digitais capturadas aleatoriamente em
            microsc&#243;pio binocular Olympus BX40 com objetiva de 40&#215;. Para a mensura&#231;&#227;o dos valores
            dos di&#226;metros dos cardiomi&#243;citos foi utilizado o <italic>software</italic> HL Image
            (Western Vision).</p>
      <p>A quantifica&#231;&#227;o de col&#225;geno foi feita por t&#233;cnica de supress&#227;o de
               <italic>pixels</italic>, sendo obtidos tr&#234;s cortes de cada ventr&#237;culo e selecionados
            cinco campos diferentes de cada corte histol&#243;gico. Foi sugerida a &#225;rea situada na por&#231;&#227;o
            m&#233;dia entre o endoc&#225;rdio e o epic&#225;rdio visceral. A medida foi realizada pelo mesmo
            observador, que n&#227;o teve conhecimento do grupo a que pertencia a l&#226;mina examinada.</p>
      <p>Para comparar o n&#237;vel hormonal, o peso total do cora&#231;&#227;o, o peso ventricular esquerdo, o
            di&#226;metro transversal dos cardiomi&#243;citos e a porcentagem de col&#225;geno entre os grupos ap&#243;s
            o tratamento, utilizou-se a an&#225;lise de vari&#226;ncia (Anova) complementada, quando
            necess&#225;rio, pelo teste de Tukey. Para analisar a exist&#234;ncia ou n&#227;o de correla&#231;&#227;o entre
            peso total do cora&#231;&#227;o, peso ventricular esquerdo, di&#226;metro transversal dos
            cardiomi&#243;citos e porcentagem de col&#225;geno utilizou-se o teste de correla&#231;&#227;o de
            Pearson.</p>
    </sec>
    <sec sec-type="results">
      <title>Resultados</title>
      <p>O T4 s&#233;rico foi mais elevado nos grupos HT e H + E, em compara&#231;&#227;o aos grupos C e E. Os
            valores de T3 n&#227;o diferiram entre os grupos. Os resultados encontrados s&#227;o demonstrados
            na <xref ref-type="table" rid="t01">Tabela 1</xref>.</p>
      <table-wrap id="t01">
        <label>Tabela 1</label>
        <caption>
          <title>M&#233;dia e desvio-padr&#227;o da concentra&#231;&#227;o s&#233;rica de T3 e T4 ap&#243;s seis semanas de
                  interven&#231;&#227;o</title>
        </caption>
        <table frame="hsides" rules="rows">
          <thead>
            <tr>
              <td rowspan="2">
                <bold>N&#237;vel hormonal</bold>
              </td>
              <td colspan="5" align="center">
                <bold>Grupos</bold>
              </td>
            </tr>
            <tr>
              <td align="center">
                <bold>Controle</bold>
              </td>
              <td align="center">
                <bold>Horm&#244;nio</bold>
              </td>
              <td align="center">
                <bold>Exerc&#237;cio</bold>
              </td>
              <td align="center">
                <bold>H + E</bold>
              </td>
            </tr>
          </thead>
          <tbody>
            <tr>
              <td>T3 (ng/ml)</td>
              <td>2,67 &#177; 1,31</td>
              <td>2,91 &#177; 0,99</td>
              <td>2,45 &#177; 0,9</td>
              <td>2,89 &#177; 1,89</td>
            </tr>
            <tr>
              <td>T4 (Mg/dl)</td>
              <td>9,08 &#177; 0,58</td>
              <td>13,76 &#177; 0,56<xref ref-type="table-fn" rid="t01-fn01">*</xref>
							</td>
              <td>9,81 &#177; 0,36</td>
              <td>12,47 &#177; 0,29<xref ref-type="table-fn" rid="t01-fn01">*</xref>
							</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="t01-fn01">
            <label>*</label>
            <p>p &lt; 0,05 (ANOVA-Tukey).</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
      <p>Os resultados referentes ao peso total do cora&#231;&#227;o (Pcor), peso ventricular esquerdo
            (PVE), di&#226;metro transversal dos cardiomi&#243;citos (DTC) e porcentagem de col&#225;geno s&#227;o
            demonstrados na <xref ref-type="table" rid="t02">Tabela 2</xref>.</p>
      <table-wrap id="t02">
        <label>Tabela 2</label>
        <caption>
          <title>M&#233;dia e desvio-padr&#227;o do peso do cora&#231;&#227;o, peso ventricular esquerdo e di&#226;metro
                  transversal dos cardiomi&#243;citos ap&#243;s seis semanas de interven&#231;&#227;o</title>
        </caption>
        <table frame="hsides" rules="rows">
          <thead>
            <tr>
              <td rowspan="2" align="center">
                <bold>Vari&#225;vel analisada</bold>
              </td>
              <td colspan="4" align="center">
                <bold>Grupos</bold>
              </td>
            </tr>
            <tr>
              <td align="center">
                <bold>Controle</bold>
              </td>
              <td align="center">
                <bold>Horm&#244;nio</bold>
              </td>
              <td align="center">
                <bold>Exerc&#237;cio</bold>
              </td>
              <td align="center">
                <bold>H + E</bold>
              </td>
            </tr>
          </thead>
          <tbody>
            <tr>
              <td>Peso do cora&#231;&#227;o(g)</td>
              <td>1,64 &#177; 0,18</td>
              <td>1,80 &#177; 0,1<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
              <td>1,56 &#177; 0,11</td>
              <td>1,88 &#177; 0,17<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
            </tr>
            <tr>
              <td>Peso do VE (g)</td>
              <td>0,71 &#177; 0,07</td>
              <td>0,79 &#177; 0,06<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
              <td>0,70 &#177; 0,06</td>
              <td>0,77 &#177; 0,07</td>
            </tr>
            <tr>
              <td>DTC fom)</td>
              <td>11,6 &#177; 0,63</td>
              <td>13,5 &#177; 0,77<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
              <td>12,7 &#177; 0,54<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
              <td>12,2 &#177; 0,63<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
            </tr>
            <tr>
              <td>Col&#225;geno (%)</td>
              <td>1,38 &#177; 0,28</td>
              <td>1,16 &#177; 0,24</td>
              <td>1,51 &#177; 0,33<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
              <td>2,12 &#177; 0,43<xref ref-type="table-fn" rid="t02-fn01">*</xref>
							</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="t02-fn01">
            <label>*</label>
            <p>p &lt; 0,05 (ANOVA-Tukey).</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
      <p>O Pcor foi maior nos grupos HT e H + E, em compara&#231;&#227;o aos grupos C e E. O PVE foi maior
            no grupo HT em compara&#231;&#227;o ao E. O DTC do ventr&#237;culo esquerdo foi maior nos grupos HT, E
            e H + E em compara&#231;&#227;o a C, sendo observados os maiores valores no grupo HT.</p>
      <p>A an&#225;lise da correla&#231;&#227;o entre as vari&#225;veis PCor, PVE, DTC e porcentagem de col&#225;geno dos
            grupos mostrou respostas distintas. As vari&#225;veis no grupo C mostraram correla&#231;&#227;o
            positiva entre o PVE e o PCor (r = 0,74; p &lt; 0,05). As demais compara&#231;&#245;es n&#227;o
            mostraram signific&#226;ncia.</p>
      <p>Aplicadas as mesmas an&#225;lises ao grupo HT, encontrou-se correla&#231;&#227;o positiva apenas entre
            o DTC e o PCor (r = 0,70; p &lt; 0,05).</p>
      <p>J&#225; no grupo E houve correla&#231;&#227;o positiva entre o PVE e o PCor (r = 0,67; p &lt; 0,05) e
            entre a porcentagem de col&#225;geno e PVE (r = 0,79; p &lt; 0,05). Houve ainda correla&#231;&#227;o
            negativa entre DTC e PVE (r = 0,62; p &lt; 0,05) e entre a porcentagem de col&#225;geno e DTC
            (r = 0,67; p &lt; 0,05).</p>
      <p>No grupo H + E foi encontrada correla&#231;&#227;o positiva entre PVE e PCor (r = 0,80; p &lt;
            0,05) e entre DTC e PVE (r = 0,71; p &lt; 0,05).</p>
    </sec>
    <sec sec-type="discussion">
      <title>Discuss&#227;o</title>
      <p>V&#225;rios modelos experimentais t&#234;m sido utilizados no estudo que envolve a remodela&#231;&#227;o
            card&#237;aca. O presente experimento foi conduzido com a finalidade de verificar os aspectos
            obtidos na intera&#231;&#227;o entre a estimula&#231;&#227;o produzida pelo horm&#244;nio tireoidiano e pelo
            exerc&#237;cio anaer&#243;bio na remodela&#231;&#227;o card&#237;aca.</p>
      <p>A exposi&#231;&#227;o dos animais a concentra&#231;&#245;es aumentadas de horm&#244;nio tireoidiano foi obtida
            pela detec&#231;&#227;o de n&#237;veis de T4 significantemente mais elevados no final do per&#237;odo
            experimental nos grupos que receberam levotiroxina s&#243;dica (51% grupo HT e 37% grupo H +
            E), em compara&#231;&#227;o ao grupo C. Os valores de T3 n&#227;o diferiram entre os grupos ap&#243;s o
            tratamento.</p>
      <p>O comportamento do peso total do cora&#231;&#227;o, peso ventricular esquerdo, di&#226;metro
            transversal e porcentagem de col&#225;geno dos grupos C, HT e E corrobora os resultados
            encontrados na literatura<xref ref-type="bibr" rid="B13">13</xref>
				<sup>-</sup>
				<xref ref-type="bibr" rid="B15">15</xref>.</p>
      <p>A an&#225;lise detalhada dos resultados da hipertrofia obtida no grupo que associou o
            exerc&#237;cio f&#237;sico e o horm&#244;nio tireoidiano desperta a aten&#231;&#227;o sobre duas quest&#245;es. A
            primeira diz respeito ao modelo de hipertrofia, e a segunda se refere &#224; aus&#234;ncia de
            efeito hipertr&#243;fico somat&#243;rio. Como j&#225; comentado, as hipertrofias fisiol&#243;gicas mant&#234;m
            equilibradas as rela&#231;&#245;es existentes entre as fibras musculares, a estrutura de col&#225;geno
            e a vasculariza&#231;&#227;o mioc&#225;rdica. Esse parece ser o padr&#227;o mais encontrado nas hipertrofias
            card&#237;acas derivadas do exerc&#237;cio f&#237;sico e do excesso de horm&#244;nio tireoidiano<xref ref-type="bibr" rid="B16">16</xref>.</p>
      <p>Algumas vias que, ativadas, produzem hipertrofia card&#237;aca fisiol&#243;gica est&#227;o envolvidas
            nas a&#231;&#245;es cardiovasculares do exerc&#237;cio f&#237;sico e do horm&#244;nio tireoidiano. Uma delas &#233; a
            que envolve o fator de crescimento semelhante &#224; insulina (IGF-1), que se liga ao seu
            receptor de tirosinaquinase (IGF-1R) ativando e autofosforilando res&#237;duos de tirosina
            que promovem o recrutamento e a ativa&#231;&#227;o de uma lipideoquinase, PI3K
            (fosfatidilinositol-3 quinase). Esses processos iniciam a ativa&#231;&#227;o de vias
            intracelulares que produzem o aumento da s&#237;ntese proteica e a consequente hipertrofia
               card&#237;aca<xref ref-type="bibr" rid="B17">17</xref>
				<sup>,</sup>
				<xref ref-type="bibr" rid="B18">18</xref>.</p>
      <p>Para explicar a aus&#234;ncia do efeito hipertr&#243;fico somat&#243;rio no grupo H + E, pode-se
            sugerir que tanto o exerc&#237;cio f&#237;sico quanto o horm&#244;nio tireoidiano tenham induzido
            hipertrofia utilizando a mesma via indutora, ou seja, a da PI3K-AKT-mTOR, via
            estreitamente relacionada &#224; hipertrofia card&#237;aca fisiol&#243;gica<xref ref-type="bibr" rid="B19">19</xref>. O modelo experimental utilizado no presente estudo induziu
            hipertireoidismo pelo per&#237;odo aproximado de 4,4% da vida esperada do animal (34 meses)
            e, como a ativa&#231;&#227;o da via da PI3K-AKT-mTOR se d&#225; em curto prazo de tempo, essa hip&#243;tese
            se torna bastante plaus&#237;vel. Uma alternativa a essa explica&#231;&#227;o poderia ser a de que o
            somat&#243;rio dos est&#237;mulos para a hipertrofia card&#237;aca tenha produzido um esgotamento dos
            mecanismos hipertr&#243;ficos e, assim, mesmo eventualmente atuando por vias diferentes,
            tivessem atingido um plat&#244; de resposta impedindo maior crescimento muscular card&#237;aco no
            grupo H + E.</p>
      <p>Analisando as correla&#231;&#245;es entre as vari&#225;veis estudadas, verificou-se que a exposi&#231;&#227;o ao
            horm&#244;nio tireoidiano produziu aumento do peso do cora&#231;&#227;o de forma diretamente
            proporcional ao aumento do di&#226;metro transversal dos cardiomi&#243;citos. Essa correla&#231;&#227;o
            encontrada &#233; positiva e forte. Tal fato parece estar diretamente vinculado &#224; n&#227;o
            detec&#231;&#227;o de ac&#250;mulo de col&#225;geno nos cora&#231;&#245;es do grupo HT, indicando que o aumento do
            peso do cora&#231;&#227;o &#233; dependente do aumento do di&#226;metro transversal dos cardiomi&#243;citos. Na
            literatura consultada, n&#227;o foi encontrada qualquer refer&#234;ncia a esse padr&#227;o de
            hipertrofia.</p>
      <p>A mesma an&#225;lise aplicada ao grupo E identificou que houve correla&#231;&#227;o forte e positiva
            entre peso do cora&#231;&#227;o e peso ventricular esquerdo e entre col&#225;geno e peso ventricular
            esquerdo. Houve ainda correla&#231;&#227;o negativa entre di&#226;metro transversal dos cardiomi&#243;citos
            e peso ventricular esquerdo e entre col&#225;geno e di&#226;metro transversal dos
            cardiomi&#243;citos.</p>
      <p>A correla&#231;&#227;o detectada entre o peso do cora&#231;&#227;o e o peso ventricular esquerdo restabelece
            o padr&#227;o obtido no grupo C e indica que o aumento do col&#225;geno pode estar diretamente
            implicado no aumento do peso ventricular esquerdo. Ao mesmo tempo, a correla&#231;&#227;o negativa
            entre di&#226;metro transversal dos cardiomi&#243;citos e peso ventricular esquerdo e entre
            porcentagem de col&#225;geno e di&#226;metro transversal dos cardiomi&#243;citos refor&#231;a essa hip&#243;tese
            e parece indicar que a participa&#231;&#227;o dos cardiomi&#243;citos tenha um papel menos importante
            na hipertrofia card&#237;aca, embora eles apresentem di&#226;metro transversal dos cardiomi&#243;citos
            maior do que o grupo C.</p>
      <p>A associa&#231;&#227;o do exerc&#237;cio ao horm&#244;nio manteve a correla&#231;&#227;o positiva entre o peso
            ventricular esquerdo e o peso do cora&#231;&#227;o e entre o di&#226;metro transversal dos
            cardiomi&#243;citos e o peso ventricular esquerdo, embora nenhuma correla&#231;&#227;o tenha sido
            encontrada envolvendo o col&#225;geno. Esse resultado &#233; interessante, pois o somat&#243;rio dos
            efeitos parece reduzir o ac&#250;mulo de col&#225;geno, fato que pode ter relev&#226;ncia cl&#237;nica e
            precisa ser mais bem estudado em futuros modelos experimentais.</p>
    </sec>
    <sec sec-type="conclusions">
      <title>Conclus&#227;o</title>
      <p>A associa&#231;&#227;o do horm&#244;nio tireoidiano com exerc&#237;cio f&#237;sico de elevada intensidade
            produziu hipertrofia card&#237;aca caracterizada pelo aumento do peso do cora&#231;&#227;o e di&#226;metro
            transversal dos cardiomi&#243;citos, sem aumento concomitante do ventr&#237;culo esquerdo. Essa
            associa&#231;&#227;o gerou um padr&#227;o hipertr&#243;fico n&#227;o correlacionado diretamente ao grau de
            fibrose.</p>
    </sec>
    <sec>
      <title>Contribui&#231;&#227;o dos autores</title>
      <p>Concep&#231;&#227;o e desenho da pesquisa e Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do
            intelectual: Souza FR, Resende ES; Obten&#231;&#227;o de dados, An&#225;lise estat&#237;stica e Obten&#231;&#227;o de
            financiamento: Souza FR; An&#225;lise e interpreta&#231;&#227;o dos dados: Souza FR, Lopes L, Gon&#231;alves
            A; Reda&#231;&#227;o do manuscrito: Souza FR, Chagas R, Fidale T, Rodrigues P.</p>
    </sec>
  </body>
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    <fn-group>
      <fn fn-type="financial-disclosure">
        <p><bold>Fontes de Financiamento</bold> O presente estudo foi financiado pela CAPES.</p>
      </fn>
    </fn-group>
  </back>
  <sub-article id="SA1" article-type="translation" xml:lang="en">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Articles</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title xml:lang="en">Hypertrophic response of the Association of Thyroid Hormone
               and Exercise in the Heart of Rats</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Souza</surname>
            <given-names>Fernanda Rodrigues de</given-names>
          </name>
          <xref ref-type="corresp" rid="c02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Resende</surname>
            <given-names>Elmiro Santos</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Lopes</surname>
            <given-names>Leandro</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Gon&#231;alves</surname>
            <given-names>Alexandre</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Chagas</surname>
            <given-names>Rafaella</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Fidale</surname>
            <given-names>Thiago</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rodrigues</surname>
            <given-names>Poliana</given-names>
          </name>
        </contrib>
      </contrib-group>
      <aff>
			   UFU - Universidade Federal de Uberl&#226;ndia, Uberl&#226;ndia, MG - Brazil</aff>
      <author-notes>
        <corresp id="c02"><bold>Mailing Address:</bold> Fernanda Rodrigues de Souza, Rua Cachoeira Dourada,
               115, Granada. Postal Code 38540-410, Uberl&#226;ndia MG - Brazil. E-mail:
                  <email>nandaeduca@yahoo.com.br</email>
				</corresp>
        <fn fn-type="conflict">
          <p><bold>Potential Conflict of Interest</bold> No potential conflict of interest
                  relevant to this article was reported.</p>
        </fn>
        <fn fn-type="other">
          <p><bold>Study Association</bold> This article is part of the thesis of master
                  submitted by Fernanda Rodrigues de Souza from Universidade Federal de Uberl&#226;ndia
                  (UFU).</p>
        </fn>
      </author-notes>
      <abstract xml:lang="en">
        <sec>
          <title>Background:</title>
          <p> Cardiac hypertrophy is a component of cardiac remodeling occurring in response to
                  an increase of the activity or functional overload of the heart. </p>
        </sec>
        <sec>
          <title>Objective:</title>
          <p> Assess hypertrophic response of the association of thyroid hormone and exercise
                  in the rat heart. </p>
        </sec>
        <sec>
          <title>Methods:</title>
          <p> We used 37 Wistar rats, male, adults were randomly divided into four groups:
                  control, hormone (TH), exercise (E), thyroid hormone and exercise (H + E); the
                  group received daily hormone levothyroxine sodium by gavage at a dose of 20 &#956;g
                  thyroid hormone/100g body weight, the exercise group took swimming five times a
                  week, with additional weight corresponding to 20% of body weight for six weeks; in
                  group H + E were applied simultaneously TH treatment groups and E. The statistics
                  used was analysis of variance, where appropriate, by Tukey test and Pearson
                  correlation test. </p>
        </sec>
        <sec>
          <title>Results:</title>
          <p> The T4 was greater in groups TH and H + E. The total weight of the heart was
                  greater in patients who received thyroid hormone and left ventricular weight was
                  greater in the TH group. The transverse diameter of cardiomyocytes increased in
                  groups TH, E and H + E. The percentage of collagen was greater in groups E and H +
                  E Correlation analysis between variables showed distinct responses. </p>
        </sec>
        <sec>
          <title>Conclusion:</title>
          <p> The association of thyroid hormone with high-intensity exercise produced cardiac
                  hypertrophy, and generated a standard hypertrophy not directly correlated to the
                  degree of fibrosis.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en">
        <kwd>Thyroid Hormones</kwd>
        <kwd>Exercise</kwd>
        <kwd>Rats</kwd>
        <kwd>Heart</kwd>
        <kwd>Hyperthyroidism</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="2"/>
        <equation-count count="0"/>
        <ref-count count="19"/>
        <page-count count="5"/>
      </counts>
    </front-stub>
    <body>
      <sec sec-type="intro">
        <title>Introduction</title>
        <p>The thyroid hormone and physical exercise produce general elevation of basal
               metabolism and as a consequence, there occurs a greater oxygen consumption by the
               tissues. This increased demand is supplied, in part, by elevation of cardiac
               frequency, blood pressure, both systolic and diastolic, and cardiac output<xref ref-type="bibr" rid="B01">1</xref>.</p>
        <p>Clinical and experimental trials suggest that cardiac adaptations are the result of
               direct effects of the hormone on the heart and blood vessels, and indirectly result
               from serum elevation of cathecolamines<xref ref-type="bibr" rid="B02">2</xref>.</p>
        <p>Cardiac hypertrophy is a component of cardiac remodeling involving changes in the
               geometric structure, the biochemical composition, the generation and electric
               conduction, the volume of muscle cells in the organization of collagen matrix and
               blood vessels. It results from changes of genetic, humoral and molecular nature that
               can arise spontaneously or be induced by stressing mechanisms of different types and
               various forms of action<xref ref-type="bibr" rid="B03">3</xref>.</p>
        <p>Physical training, within reasonable limits, induces cardiac hypertrophy of the
               physiological type, producing adaptations that improve the performance of the
               cardiovascular system allowing the heart to withstand increases in demands during
               exercise. Cardiac hypertrophy is accompanied by increase in ventricular filling time
               and ejection fraction of the left ventricle, with consequent reduction of the heart
               rate at rest<xref ref-type="bibr" rid="B04">4</xref>
					<sup>,</sup>
					<xref ref-type="bibr" rid="B05">5</xref>.</p>
        <p>The main differences that determine the pattern of cardiac hypertrophy are the type
               and duration of stimulation that the heart receives. In situations in which athletes
               receive pressure overloads only during physical activity, cardiac hypertrophy is
               usually physiological. In contrast, in pathological situations the heart is
               continuously exposed to functional overload that occurs for a long time, determining
               pathological hypertrophy<xref ref-type="bibr" rid="B06">6</xref>.</p>
        <p>The excess thyroid hormone can promote these two patterns of hypertrophy described
               above (mixed cardiac hypertrophy). This response appears to be due, in part, the
               volume of overload due to increased venous return produced by the TH and also the
               direct effects of horm&#244;nio<xref ref-type="bibr" rid="B07">7</xref>
					<sup>,</sup>
					<xref ref-type="bibr" rid="B08">8</xref>.</p>
      </sec>
      <sec>
        <title>Objective</title>
        <p>Evaluate the hypertrophic response of the association of the thyroid hormone and
               exercise in the heart of rats.</p>
      </sec>
      <sec sec-type="methods">
        <title>Method</title>
        <p>The procedures were performed after approval of the study protocol by the Ethics
               Committee on animal use of the institution under the numbers 077/10. The study
               conducted was of the experimental type.</p>
        <p>We used 37 adult Wistar rats, male, weighing approximately 250 grams, derived from
               the laboratory of animal experiments (CEBEA-UFU). The environmental conditions for
               all groups were similar with regard to temperature, relative humidity of the air,
               level of noise and brightness in accordance with the circadian rhythm. The rats were
               fed with ration and water <italic>"ad libitum"</italic>.</p>
        <p>The rats were weighed and randomly divided into four groups identified as: control
               (C) 8 animals, hormone (TH) 10 animals, exercise (E) 9 animals, hormone and exercise
               (H+E) 10 animals; after distributed, the animals underwent an adjustment period of 15
               days in the laboratory before the experiment started.</p>
        <p>The type of exercise used was of an anaerobic character. For training, we used a
               glass with 250 mm in diameter<xref ref-type="bibr" rid="B09">9</xref>. The water
               column height in the glass corresponded to 150% of the rat's body length. The water
               temperature was maintained between 30&#176;C and 32&#176;C, which is considered thermally
               neutral in relation to body temperature of the animal<xref ref-type="bibr" rid="B10">10</xref>. The load used in training was that corresponding to 20% of body weight
               of the rate because this is considered to be an overload that increases the
               concentration of lactate<xref ref-type="bibr" rid="B11">11</xref>. The referred work
               load consisted of lead blocks fixed to a vest in the region before the rats' trunk.
               The load was adjusted weekly according to the variation in the weight of the
               animals.</p>
        <p>The training period was started after 7 days of adaptation to the water mean.
               Training was conducted in 6 weeks and consisted of five weekly sessions of swimming
               limited by exhaustion.</p>
        <p>The hormone was administered by means of oro-gastric probing performed once a day for
               6 weeks. The dose of thyroid hormone was 20 &#956;g/100 g of body weight of a suspension
               of T4 at 0.1% which was obtained from 10 mg tablets of 100 &#181;g of T4 diluted in 10 ml
               of distilled water<xref ref-type="bibr" rid="B12">12</xref>.</p>
        <p>After the 6 weeks of the experiment, the rats were sacrificed under anesthesia,
               proceeding to open the chest for blood collection by direct cardiac puncture and
               removal of the heart. Confirmation of exposure to high levels of thyroid hormone was
               performed by serum dosage of T3 and T4 by the ELISA method.</p>
        <p>The heart was weighed and preserved in formaldehyde; this process lasted 24 hours.
               After the use of formaldehyde, the atria were removed and separated from the
               ventricles for weighing; the material was then forwarded for histological
               processing.</p>
        <p>To analyze the transverse diameters of cardiomyocytes, slides were stained with
               eosin/ hematoxylin and to quantify collagen, the slides were stained with
               picrosirius. We obtained five sections of each ventricle and measured the smallest
               diameters of five cells (with visible core) in five different fields. For measures,
               we made analyses on digital images captured randomly by an Olympus BX40 binocular
               microscope with a 40&#215; objective. To measure the values of the diameters of
               cardiomyocytes, we used software HL Image (Western Vision).</p>
        <p>The quantification of collagen was made by suppression technique of pixels, where
               three sections were obtained from each ventricle and selected five different fields
               of each histological section. It was suggested that the area located in the middle
               portion between the visceral endocardium and epicardium. The measurement was
               performed by a single observer who was unaware of which group belonged to the slide
               examined.</p>
        <p>To compare the level of hormone, total weight of the heart, left ventricular weight,
               cardiomyocyte transversal diameter and percent of collagen between the groups after
               treatment, was carried out using complemented variance analysis (ANOVA) where
               necessary by Tukey's test. To analyze the existence or not of correlation between
               total weight of the heart, left ventricular weight, cardiomyocyte transversal
               diameter and percentage of collagen, we used Pearson's correlation test.</p>
      </sec>
      <sec sec-type="results">
        <title>Results</title>
        <p>The serum T4 was greater in groups TH and H+E, compared to groups C and E. The values
               of T3 did not differ among the groups. The results found are shown in <xref ref-type="table" rid="t03">Table 1</xref>.</p>
        <table-wrap id="t03">
          <label>Table 1</label>
          <caption>
            <title>Mean and standard deviation of serum concentration of T3 and T4 after six
                     weeks of intervention</title>
          </caption>
          <table frame="hsides" rules="rows">
            <thead>
              <tr>
                <td rowspan="2">
                  <bold>Hormone Level</bold>
                </td>
                <td colspan="4" align="center">
                  <bold>
                    <italic>Groups</italic>
                  </bold>
                </td>
              </tr>
              <tr>
                <td align="center">
                  <bold>CONTROL</bold>
                </td>
                <td align="center">
                  <bold>HORMONE</bold>
                </td>
                <td align="center">
                  <bold> EXERCISE</bold>
                </td>
                <td align="center">
                  <bold>H + E</bold>
                </td>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td>T3(&#956;g/ml)</td>
                <td align="center">2.67 &#177; 1.31</td>
                <td align="center">2.91 &#177; 0.99</td>
                <td align="center"> 2.45 &#177; 0.9</td>
                <td align="center">2.89 &#177; 1.89</td>
              </tr>
              <tr>
                <td>T4(Mg/dl)</td>
                <td align="center">9.08 &#177; 0.58</td>
                <td align="center">13.76 &#177; 0.56<xref ref-type="table-fn" rid="t03-fn01">*</xref>
								</td>
                <td align="center"> 9,81 &#177; 0.36</td>
                <td align="center">12.47 &#177; 0.29<xref ref-type="table-fn" rid="t03-fn01">*</xref>
								</td>
              </tr>
            </tbody>
          </table>
          <table-wrap-foot>
            <fn id="t03-fn01">
              <label>*</label>
              <p>p &lt; 0,05 (ANOVA-Tukey)</p>
            </fn>
          </table-wrap-foot>
        </table-wrap>
        <p>The results relative to the total weight of the heart (Pcor), left ventricular weight
               (LVW), cardiomyocyte transversal diameter (CTD) and the percentage of collagen are
               shown in <xref ref-type="table" rid="t04">Table 2</xref>.</p>
        <table-wrap id="t04">
          <label>Table 2</label>
          <caption>
            <title>Mean and standard deviation of the heart weight, left ventricular weight
                     and transversal diameter of cardiomyocites after six weeks of
                     intervention</title>
          </caption>
          <table frame="hsides" rules="rows">
            <thead>
              <tr>
                <td rowspan="2" align="center">
                  <bold>VARIABLE ANALYZED</bold>
                </td>
                <td colspan="4" align="center">
                  <bold>Groups</bold>
                </td>
              </tr>
              <tr>
                <td align="center">
                  <bold>CONTROL</bold>
                </td>
                <td align="center">
                  <bold>HORMONE</bold>
                </td>
                <td align="center">
                  <bold>EXERCISE</bold>
                </td>
                <td align="center">
                  <bold>H+E</bold>
                </td>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td>Heart weight(g)</td>
                <td align="center">1.64 &#177; 0.18</td>
                <td align="center">1.80 &#177; 0.1<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
                <td align="center">1.56 &#177; 0.11</td>
                <td align="center">1.88 &#177; 0.17<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
              </tr>
              <tr>
                <td>LV weight(g)</td>
                <td align="center">0.71 &#177; 0.07</td>
                <td align="center">0.79 &#177; 0.06<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
                <td align="center">0.70 &#177; 0.06</td>
                <td align="center">0.77 &#177; 0.07</td>
              </tr>
              <tr>
                <td>CDT(pm)</td>
                <td align="center">11.6 &#177; 0.63</td>
                <td align="center">13.5 &#177; 0.77<xref ref-type="table-fn" rid="t04-fn01">*</xref>
									<sup>f</sup>
								</td>
                <td align="center">12.7 &#177; 0.54<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
                <td align="center">12.2 &#177; 0.63<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
              </tr>
              <tr>
                <td>Collagen (%)</td>
                <td align="center">1.38 &#177; 0.28</td>
                <td align="center">1.16 &#177; 0.24</td>
                <td align="center">1.51 &#177; 0.33<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
                <td align="center">2.12 &#177; 0.43<xref ref-type="table-fn" rid="t04-fn01">*</xref>
								</td>
              </tr>
            </tbody>
          </table>
          <table-wrap-foot>
            <fn id="t04-fn01">
              <label>*</label>
              <p>p &lt; 0,05 (ANOVA-Tukey)</p>
            </fn>
          </table-wrap-foot>
        </table-wrap>
        <p>PCor was greater in groups TH and HE, compared to groups C and E. LVW was greater in
               group TH in comparison with E. CDT of the left ventricle was greater in groups TH, E
               and H+E in comparison to C, being observed the highest values in group TH.</p>
        <p>Correlation analysis between variables PCor, LVW, CDT and percentage of collagen of
               the groups showed different responses. The variables in group C showed positive
               correlation between LVW and PCor (r = 0.74; p &lt; 0.05). The other comparisons did
               not prove significant.</p>
        <p>Applying the same analyses to group TH, we found a positive correlation only between
               CDT and PCor (r = 0.70; p &lt; 0.05).</p>
        <p>In group E there was a positive correlation between LVW and PCor (r = 0.67, p &lt;
               0.05) and between the percentage of collagen and LVW (r = 0.79, p &lt; 0.05). There
               was also a negative correlation between CDT and LVW (r = 0.62; p &lt; 0.05) and
               between the percentage of collagen and CDT (r = 0.67; p &lt; 0.05).</p>
        <p>In the H+E group was a positive correlation between LVW and PCor (r = 0.80, p &lt;
               0.05) and between CDT and LVW (r = 0.71, p &lt; 0.05).</p>
      </sec>
      <sec sec-type="discussion">
        <title>Discussion</title>
        <p>Several experimental models have been used in the study involving cardiac remodeling.
               This experiment was conducted in order to check aspects obtained in the interaction
               between stimulation produced by the thyroid hormone and by the anaerobic exercise in
               cardiac remodeling.</p>
        <p>Exposure of animals to increased concentrations of thyroid hormone was obtained by
               detecting levels of T4 significantly greater at the end of the trial period in the
               groups receiving levothyroxine sodium (51% group HT and 37% group H+E) compared to
               group C. The values of T3 did not differ from the post-treatment groups.</p>
        <p>The behavior of the total weight of the heart, left ventricular weight, transverse
               diameter and percentage of collagen in groups C, HT and E corroborate the results
               found in the literature<xref ref-type="bibr" rid="B13">13</xref>
					<sup>-</sup>
					<xref ref-type="bibr" rid="B15">15</xref>.</p>
        <p>Detailed analysis of the results obtained of the hypertrophy obtained in the group
               that associated physical exercise and thyroid hormone, draws the attention on two
               issues. The first of them concerns the model of hypertrophy and the second refers to
               the absence of added hypertrophic effect. As already mentioned, physiological
               hypertrophy maintains existing relations between the muscle fibers, the collagen
               structure and myocardial vascularization. This opinion seems to be the pattern mostly
               found in cardiac hypertrophy derived from exercises and excess thyroid hormone<xref ref-type="bibr" rid="B16">16</xref>.</p>
        <p>A few pathways, which, activated, produce physiological cardiac hypertrophy, are
               involved in the cardiovascular actions of exercise and thyroid hormone. One of the is
               that which involves the growth factor similar to insulin (IGF-1) which binds to its
               receptor of tyrosine kinase (IGF-1R) activating and autophosphorylating tyrosine
               residues that promote recruitment and activation of a lipid kinase PI3K
               (phosphatidylinositol-3-kinase). These processes start the activation of
               intracellular pathways that produce increased protein synthesis and consequent
               cardiac hypertrophy<xref ref-type="bibr" rid="B17">17</xref>
					<sup>,</sup>
					<xref ref-type="bibr" rid="B18">18</xref>. </p>
        <p>To explain the lack of added hypertrophic effect in the H+E group, it can be
               suggested that both physical exercise as thyroid hormone have induced hypertrophy
               using the same inducing pathway, that is, that of PI3K-AKT-mTOR a pathway which is
               closely related to physiological cardiac hypertrophy<xref ref-type="bibr" rid="B19">19</xref>. The experimental model used in this study induced hyperthyroidism by
               an approximate period of 4.4% of the animal's expected life (34 months) and as the
               activation of the pathway of PI3K-AKT-mTOR takes place in a short period of time,
               this hypothesis becomes quite plausible. An alternative to this explanation could be
               that the sum of the stimuli to cardiac hypertrophy has produced a depletion of
               hypertrophic mechanisms and thus possibly even acting through different pathways,
               they had reached a plateau of response preventing further growth in the cardiac
               muscle in the H+E group.</p>
        <p>Analyzing the correlations between the studied variables, it was found that exposure
               to thyroid hormone produced an increase in heart weight in a direct proportion to the
               increase in the transverse diameter of cardiomyocytes. This correlation found is
               positive and strong. This fact seems to be directly linked to the failure to detect
               accumulation of collagen in the hearts of the HT group indicating that the increase
               in heart weight is dependent on the increase in the transverse diameter of
               cardiomyocytes. In the literature consulted, we did not find any reference to this
               pattern of hypertrophy.</p>
        <p>The same analysis applied to group E, identified that there was strong and positive
               correlation between heart weight and left ventricular weight and between collagen and
               left ventricular weight. There was also a negative correlation between the transverse
               diameter of cardiomyocytes and left ventricular weight and between collagen and
               transverse diameter of cardiomyocytes.</p>
        <p>The detected correlation between the weight of the heart and left ventricular weight
               restores the pattern obtained in group C and indicates that the increased collagen
               may be directly implicated in increased left ventricular weight. At the same time,
               the negative correlation between the transverse diameter of cardiomyocytes and left
               ventricular weight and the percentage of collagen and the transverse diameter of
               cardiomyocytes reinforce this hypothesis and seem to suggest that the participation
               of cardiomyocytes, although showing a transverse diameter of cardiomyocytes greater
               than that of group C, has a less important role on cardiac hypertrophy.</p>
        <p>The association of exercise to the hormone maintained the positive correlation
               between left ventricular weight and heart weight and between the transverse diameter
               of cardiomyocytes and left ventricular weight, although no correlation has been found
               involving collagen. This result is interesting because the sum of the effects appears
               to reduce the accumulation of collagen, a fact which may have clinical relevance and
               needs to be further studied in future experimental models.</p>
      </sec>
      <sec sec-type="conclusions">
        <title>Conclusion</title>
        <p>The association of thyroid hormone with high-intensity exercise produced cardiac
               hypertrophy characterized by increased heart weight and transverse diameter of
               cardiomyocytes without concomitant increase of the left ventricle.</p>
        <p>This association led to a hypertrophic pattern not directly correlated to the degree
               of fibrosis.</p>
      </sec>
      <sec>
        <title>Author contributions</title>
        <p>Conception and design of the research and Critical revision of the manuscript for
               intellectual content: Souza FR, Resende ES; Acquisition of data, Statistical analysis
               and Obtaining funding: Souza FR; Analysis and interpretation of the data: Souza FR,
               Lopes L, Gon&#231;alves A; Writing of the manuscript: Souza FR, Chagas R, Fidale T,
               Rodrigues P.</p>
      </sec>
    </body>
    <back>
      <fn-group>
        <fn fn-type="financial-disclosure">
          <p><bold>Sources of Funding</bold> This study was funded by CAPES.</p>
        </fn>
      </fn-group>
    </back>
  </sub-article>
</article>
