Emagrecimento e desempenho cardíaco / Weight loss and cardiac performance

RACIONAL: As doenças cardiovasculares representam as complicações mais frequentemente associadas à obesidade. O emagrecimento determina diminuição da pressão arterial e melhora nos parâmetros dos lipídeos e glicose séricos. A perda de peso e sua manutenção reduzem os fatores de risco para doenças cardiovasculares, tornando, reversíveis as alterações cardíacas decorrentes da obesidade. OBJETIVO: Avaliar o efeito da perda de peso sobre a capacidade física e as alterações estruturais e funcionais do coração de obesos submetidos à procedimento cirúrgico bariátrico. MÉTODOS: Quarenta e três pacientes submetidos à derivação gástrica em Y-de-Roux, foram analisados por eletrocardiograma, teste ergométrico e ecodopplercardiograma no pré-operatório e um ano após a derivação. Na análise estatística utilizaram-se os testes de Wilcoxon, t de Student, Shapiro-Wilk com nível de significância de 5 por cento. RESULTADOS: O peso diminuiu de 116,5 kg ± 21,5 para 80 kg ± 15,9; o IMC de 41,8kg/m2 ± 4,4 para 28,4kg/m2 ± 3,8; a frequência cardíaca reduziu de 77,9 bpm ± 9,6 para 70,9bpm ± 7,8; a pressão sistólica de 130 mmHg ± 20 para 120mmHg ± 10; a diastólica de 80 mmHg ± 10 para 80 mmHg ± 0. O teste ergométrico mostrou aumentos na distância percorrida de 378,9m ± 126,5m para 595m ± 140,4; no coeficiente metabólico (MET) de 6,7 ± 2,4 ml de O2/kg/min para 8,3 ± 2,6ml de O2/kg/min; no consumo de oxigênio (VO2) de 23,1 ± 8,4 para 30 ± 10,3. O ecodopplercardiograma mostrou redução no septo interventricular de 12 mm ± 2 para 10 mm ± 1; parede posterior de 11 mm ± 2 para 10 mm ± 1; massa ventricular de 273 g ± 85 para 216g ± 60. Houve melhora na função diastólica com aumento na relação E'/A'e E/A e da fração de ejeção com elevação de 70,2 por cento ± 7,2 para 72,9 por cento ± 6,4. CONCLUSÃO: Obesos submetidos à cirurgia bariátrica apresentaram melhora na capacidade física e melhora estrutural e funcional do coração.

BACKGROUND: Cardiovascular diseases are the most frequent complications associated with obesity. The weight loss determine blood pressure decrease and improvement in parameters of lipid and glucose levels. Weight loss and maintenance reduce the risk factors for cardiovascular disease, making reversible cardiac changes resulting from obesity. AIM: To evaluate the effect of weight loss on physical capacity and the structural and functional heart of obese patients undergoing to bariatric surgery. METHODS: Forty-three patients who underwent gastric Roux-en-Y bypass, were analyzed by ECG, and echocardiography preoperatively and one year after the bypass. Statistical analysis used the Wilcoxon and Student t test, Shapiro-Wilk test with a significance level of 5 percent. RESULTS: The weight decreased from 116.5 kg to 21.5 ± 15.9 ± 80 kg, BMI of 41.8 kg/m 2 ± 4.4 to 28.4 kg/m 2 ± 3.8, heart rate decreased from 77.9 ± 9.6 bpm to 70.9 ± 7.8 bpm, systolic pressure of 130 ± 20 mmHg to 120 mmHg ± 10, diastolic 80 mmHg ± 10 mmHg to 80 ± 0. The exercise test showed increases in distance traveled of 378.9 m ± ​​126.5 m to 140.4 ± 595m; coefficient in metabolic equivalents (METs) from 6.7 ± 2.4 ml O 2 / kg / min to 8.3 ± 2.6 ml O 2 / kg / min, oxygen consumption (VO 2) 23.1 ± 8.4 to 10.3 ± 30. The echocardiogram showed a reduction in the interventricular septum of 12 mm to 10 mm ± 2 ± 1; posterior wall of 11 mm to 10 mm ± 2 ± 1; ventricular mass of 273 ± 85 g to 216g ± 60. There was improvement in diastolic function with increase in E '/ A'e E / A and ejection fraction with an increase of 70.2 percent ± 7.2 to 72.9 ± 6.4 percent. CONCLUSION: Obese patients undergoing bariatric surgery showed improvement in physical capacity and in the structure/functioning of the heart.

Morphofunctional evaluation of the heart of obese patients before and after bariatric surgery.

BACKGROUND: This study aims to evaluate the effect of weight loss on the physical capacity and the structure and function of the heart after bariatric surgery. METHODS: Forty-three adult obese patients, 31 women (72.1%) and 12 men (27.9%), were submitted to electrocardiogram, ergometric test, and echo Doppler cardiogram at presurgical stage and 1 year after Roux-en-Y gastric bypass. The statistical analysis utilized the Wilcoxon, Student's t, and Shapiro-Wilk tests with 5% significance level. RESULTS: Weight was reduced from 116.5 ± 21.5 to 80 ± 15.9 kg and body mass index from 41.8 ± 4.4 to 28.4 ± 3.8 kg/m(2). Cardiac frequency was reduced from 77.9 ± 9.6 to 70.9 ± 7.8 bpm, systolic pressure from 130 ± 20 to 120 ± 10 mmHg, and diastolic pressure from 80 ± 10 to 80 ± 0 mmHg. Ergometric tests showed distance covered from 378.9 ± 126.5 to 595 ± 140.4 m, metabolic coefficient from 6.7 ± 2.4 to 8.3 ± 2.6 ml O(2)/kg/min, and oxygen consumption (VO(2)) from 23.1 ± 8.4 to 30 ± 10.3 metabolic equivalents of task. The echo Doppler cardiogram showed interventricular septum from 12 ± 2 to 10 ± 1 mm, posterior wall from 11 ± 2 to 10 ± 1 mm, and ventricular mass from 273 ± 85 to 216 ± 60 g. There was improvement in the diastolic function with an increase in the E'/A' and E/A relationship and the ejection fraction with an increase from 70.2 ± 7.2% to 72.9 ± 6.4%. CONCLUSIONS: Bariatric surgery improved physical capacity as well as structural and functional improvement of the heart.

Avaliação cardiológica tardia de crianças com insuficiência mitral reumática, submetidas a cirurgia reconstrutora com anel de Gregori / Late heart evaluation of children with rheumatic mitral regurgitation submitted to reconstructive surgery with implantation of Gregori's ring

OBJETIVO: Avaliar crianças com insuficiência mitral reumática (IMR) submetidas a cirurgia reconstrutora na valva mitral com implante do anel de Gregori (CRVM), de 1987 a 2003. MÉTODOS: Quarenta e três crianças com IMR, submetidas a CRVM, com idades variando de cinco a doze anos, média de 9,7 ± 2,2 anos, sendo 25 (58,1 por cento) pacientes do sexo feminino. Os pacientes foram avaliados mediante parâmetros clínicos: classe funcional de insuficiência cardíaca, ausculta cardíaca, eletrocardiograma, radiografia de tórax e parâmetros ecocardiográficos. RESULTADOS: Quarenta e três pacientes foram avaliados no préoperatório e, no pós, 31, em virtude de seis óbitos e seis trocas valvares. O seguimento foi de 100 por cento. A classe funcional da insuficiência cardíaca, sopro sistólico mitral, área cardíaca pela radiografia de tórax, sobrecarga ventricular esquerda no eletrocardiograma e o grau de insuficiência mitral pelo ecocardiograma diminuíram significativamente. Após 188 meses a taxa de sobrevida foi de 82 por cento e a de mortalidade anual de 0,38 por cento. Estavam livres de reoperação 31 (72,6 por cento) pacientes, e a taxa de reoperação anual foi de 0,51 por cento. CONCLUSÃO: A CRVM apresenta resultados eficazes no tratamento da IMR em crianças, com melhora significativa na classe funcional, sopro sistólico mitral e grau de insuficiência mitral pelo ecocardiograma.

[Late heart evaluation of children with rheumatic mitral regurgitation submitted to reconstructive surgery with implantation of Gregori's ring]. / Avaliação cardiológica tardia de crianças com insuficiência mitral reumática, submetidas a cirurgia reconstrutora com anel de Gregori.

OBJECTIVE: Assess late cardiological evolution of children with rheumatic mitral regurgitation (RMR) who underwent mitral valve reconstructive surgery with implantation of Gregori's ring (MVR), from 1987 to 2003. METHODS: A study was conducted to analyze a series of cases of 43 children with RMR who underwent MVR with ages ranged from five to twelve years (mean age 9.7 +/- 2.2 years); 25 of the patients were females (58.1%). Patients were evaluated as per the following clinical parameters: functional class of heart failure, heart auscultation, electrocardiogram, chest X-ray and echocardiographic findings. RESULTS: Forty-three patients underwent preoperative evaluation during the postoperative period, the number of patients evaluated decreased to 31 due to the fact that 6 patients had died and 6 others underwent valve replacement surgery. Follow-up was carried out for 100% of the patients. A significant reduction of heart failure functional class was observed. Mitral systolic murmur became less intense during the postoperative period. The cardiac area on chest X-ray and the presence of left ventricular overload on electrocardiogram were reduced, as well as the mitral regurgitation level on echocardiographic study. After 188 months, the survival rate was 82%, and the annual mortality rate, 0.38%. Thirty-one (72.6%) patients did not require reoperation and the annual rate of patients who required further surgery was 0.51%. CONCLUSION: MVR is an effective procedure for treating RMR in children, resulting in a significant improvement of functional class, mitral systolic murmur and level of mitral regurgitation, as shown on Doppler echocardiogram.