There was an obvious cardiac autonomic improvement after surgery. Despite the improvement in exercise tolerance, patients undergoing bariatric surgery had lower maximum oxygen consumption in the analysis not corrected for body weight. The mean VORP before bariatric surgery was 141 s and was 111 s after the surgical procedure (p < 0.001). These results suggest an improvement in the recovery kinetics of oxygen consumption, a novel index of cardiac reserve capacity, on patients undergoing bariatric surgery.

BackgroundLeft ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF.ObjetiveCorrelate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria.MethodsSystolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO2, VE/VCO2 slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO2 in 50% after physical exercise (T1/2VO2). ROC curve analysis of GLS to predict VO2 < 14 mL/kg/min and VE/VCO2 slope > 35 (heart transplantation’s criteria) was performed.ResultsTwenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO2 and T1/2VO2. GLS correlated to all CPET variables (maxVO2: r = 0.671, p = 0.001; VE/VCO2 slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T1/2VO2: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation’s criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03.ConclusionGLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.

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Objective: Measure the systolic (SP), diastolic (DP) and pulse pressure (PP) using home blood pressure monitoring (HBPM) and correlate their values with the left ventricular mass index (LVMI)Methods: In 2004, 127 individuals underwent HBPM in a private clinic. A total of 83 of these individuals had also undergone an echocardiographic study within a period shorter than 6 months. After excluding those with dilated or ischemic cardiomyopathy and those with mitral or aortic valvopathies, 72 patients were evaluated for the correlation between SP, DP and PP (SP minus DP) and the LVMI. Results:The group´s mean age was 51.9±17.3 years and males represented 43% of the sample. The mean body mass index (BMI) was 28.6±6 Kg/m 2 and 53% of the patients were using antihypertensive drugs. The PS and PP correlated positively to the LVMI (r = 0.356; p=0.002 and r=0.429; p<0.001, respectively). There was no correlation between DP and LVMI. Conclusion:The PS and the PP correlate positively to the LVMI.

Male, 34-years-old, developed a rapidly progressive heart failure four years ago, resulting from a left ventricular (LV) noncompaction cardiomyopathy according to findings from magnetic resonance angiography. The initial electrocardiogram (Fig. 1) showed a first-degree AV block, left ventricular and left atrial overload and left bundle branch block, with SÂT at +30°, and biphasic T waves in D1 and V6. Recently, after a viral infection of the respiratory tract he presented with a severe exertional limitation. Doppler echocardiogram (Fig. 2) demonstrated diffuse hypokinesia and a significant decrease in LV ejection fraction (0.38) with mild mitral regurgitation, final LV diastolic diameter of 6.3cm and final systolic diameter of 5.1 cm, in addition to detecting the characteristic trabeculations in the internal face of the septal-apical myocardium with Key wordsLeft bundle branch block, circumferential subendocardial ischemia, non-compacted myocardium. intratrabecular blood flow. ECG (Figure 3) showed a higher degree of aberrant ventricular activation and significant T wave inversion in anterolateral and inferior walls, with a diametrically opposed SÂT at -145°. CommentsThe electrocardiographic concept of circumferential subendocardial ischemia because of SÂT displacement to the right upper quadrant in the three-vessel coronary artery disease or the like, indicative of a sudden increase in LV end-diastolic pressure, may be pertinent to this form of cardiomyopathy, for which information on ECG alterations is scarce.

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