Myocardial perfusion scintigraphy in myocardial infarction - impact of ST-segment elevation and of Diabetes mellitus.

Myocardial perfusion scintigraphy (MPS) is frequently used in the evaluation of patients with coronary artery disease, either stable or with the prior remote acute coronary syndrome. The goal of the present work was to evaluate changes in MPS according to the nature of the infarction (ST-elevation vs non-ST elevation status) as well as according to the presence or absence of Diabetes mellitus. A prospective study of 124 consecutive patients with myocardial infarction (MI) was carried out using MPS. Patients with ST-segment elevation MI (STEMI) had significantly larger values both for percentage and absolute areas of perfusion defects, both at rest and in a stress situation, when compared to patients without ST-segment elevation (NSTEMI). These patients had significantly lower values for left ventricular ejection fractions (EF), in a similar comparison. The values for perfusion defects at rest for STEMI patients were more than double the values for NSTEMI patients (17.1 ±â€Š14.6% vs 6.5 ±â€Š7.8%, P < .001). Concerning resting left ventricular EF, STEMI patients had a mean value of 47.6 ±â€Š13.6% and NSTEMI patients had a mean value of 53.2 ±â€Š12.4% (P.026). Regarding the comparison between patients with and without Diabetes mellitus, none of the parameters under study showed significant differences. Linear regression analysis, taking the percentage of perfusion defect, as the dependent variable, yielded an overall significant result, however, only ST-segment elevation was shown to have an individually significant result. We conclude that the presence of ST-segment elevation but not the presence of Diabetes mellitus is associated with different patterns of MPS in patients with MI.

Frequência de fatores de risco cardiovascular antes e 6 e 12 meses após gastroplastia / Frequency of cardiovascular risk factors before and 6 and 12 months after bariatric surgery

OBJETIVO: Comparar a frequência dos fatores de risco cardiovascular (FRCV) em obesos com indicação de gastroplastia no pré-operatório e após o sexto mês e o primeiro ano do procedimento, em usuários do Sistema Único de Saúde. MÉTODOS: Foi realizado estudo observacional, longitudinal, prospectivo e analítico, com seleção consecutiva de obesos com indicação cirúrgica, encaminhados para avaliação cardiológica pré-operatória. O protocolo foi constituído de: história clínica, exame físico, eletrocardiograma, ecocardiograma e dosagens bioquímicas. No presente estudo, foram analisadas as seguintes variáveis: peso, índice de massa corporal (IMC), circunferência abdominal (CA), hipertensão arterial Sistêmica (HAS), diabetes mellitus-tipo 2 (DM), dislipidemia (colesterol LDL elevado; colesterol HDL baixo; hipertrigliceridemia) e síndrome metabólica (SM). Para análise estatística foram utilizados os métodos do Qui-quadrado e Tukey-Kramer. RESULTADOS: A amostra foi constituída de 96 obesos. Desses, 86 eram mulheres com idades entre 18 e 58 anos (mediana de 35 anos). Ao final de seis meses, foi observada redução significante de 88%, 95%, 71%, 89% e 80% na frequência de HAS, colesterol LDL elevado, hipertrigliceridemia, DM e SM. Apenas ao final de 12 meses houve significante e modesta redução na frequência de colesterol HDL baixo (24%) e CA anormal (31%). Em seis meses e um ano ,o peso e o IMC sofreram reduções respectivas de 33,4 e 44,3 kg e de 13,1 e 17,2 kg/m². CONCLUSÃO: O impacto positivo na perda de peso, na redução do IMC, da CA e da frequência dos FRCM mostrou-se extremamente significante após seis meses, e se manteve após um ano da gastroplastia.

OBJECTIVE: To compare the frequency of cardiovascular risk factors (CVRFs) in obese patients Obesity of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) with indication of bariatric surgery during the preoperative period and after the sixth month and the first year of the procedure. METHODS: An observational, longitudinal, prospective, and analytical study was performed, with consecutive selection of obese patients with indication for surgery referred to preoperative cardiac evaluation. The protocol consisted of: medical history, physical examination, electrocardiogram, echocardiogram, and biochemical analysis. This study analyzed the following variables:weight, body mass index (BMI),waist circumference (WC), systemic arterial hypertension (SAH), diabetes mellitus type 2(DM), dyslipidemia (high LDL cholesterol; low HDL cholesterol; hypertriglyceridemia), and metabolic syndrome (MS). The chi-squared test and the Tukey-Kramer method were used for statistical analysis. RESULTS: The sample was composed of 96 obese people, among which 86 were women, aged between 18 and 58 years old (median 35 years old). At the end of six months, significant reductions of 88%, 95%, 71%, 89%, and 80% in the frequency of SAH, high LDL cholesterol, hypertriglyceridemia, DM, and MS could already be observed. A significant and small reduction in the frequency of low HDL cholesterol (24%) and abnormal WC (31%) was observed only at the end of 12 months. After six months and one year, weight and BMI experienced reductions of 33.4 kg and 44.3 kg, and 13.1 kg/m2 and 17.2 kg/m2, respectively. CONCLUSION: The positive impact on weight loss and the reduction in BMI, WC, and in the frequency of CVRFs are already extremely significant after six months and remain so one year after bariatric surgery.

Frequency of cardiovascular risk factors before and 6 and 12 months after bariatric surgery.

OBJECTIVE: To compare the frequency of cardiovascular risk factors (CVRFs) in obese patients of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) with indication of bariatric surgery during the preoperative period and after the sixth month and the first year of the procedure. METHODS: An observational, longitudinal, prospective, and analytical study was performed, with consecutive selection of obese patients with indication for surgery referred to preoperative cardiac evaluation. The protocol consisted of: medical history, physical examination, electrocardiogram, echocardiogram, and biochemical analysis. This study analyzed the following variables: weight, body mass index (BMI), waist circumference (WC), systemic arterial hypertension (SAH), diabetes mellitus type 2(DM), dyslipidemia (high LDL cholesterol; low HDL cholesterol; hypertriglyceridemia), and metabolic syndrome (MS). The chi-squared test and the Tukey-Kramer method were used for statistical analysis. RESULTS: The sample was composed of 96 obese people, among which 86 were women, aged between 18 and 58 years old (median 35 years old). At the end of six months, significant reductions of 88%, 95%, 71%, 89%, and 80% in the frequency of SAH, high LDL cholesterol, hypertriglyceridemia, DM, and MS could already be observed. A significant and small reduction in the frequency of low HDL cholesterol (24%) and abnormal WC (31%) was observed only at the end of 12 months. After six months and one year, weight and BMI experienced reductions of 33.4kg and 44.3kg, and 13.1kg/m(2) and 17.2kg/m(2), respectively. CONCLUSION: The positive impact on weight loss and the reduction in BMI, WC, and in the frequency of CVRFs are already extremely significant after six months and remain so one year after bariatric surgery.

Determinants of weight regain after bariatric surgery.

BACKGROUND: Bariatric surgery leads to an average loss of 60-75% of excess body weight with maximum weight loss in the period between 18 and 24 months postoperatively. However, several studies show that weight is regained from two years of operation. AIM: To identify the determinants of weight regain in post-bariatric surgery users. METHODS: Prospective cross-sectional study with 64 patients who underwent bariatric surgery with postoperative time > 2 years valued at significant weight regain. The variables analyzed were age, sex, education, socioeconomic status, work activity related to food, time after surgery, BMI, percentage of excess weight loss, weight gain, attendance monitoring nutrition, lifestyle, eating habits, self-perception of appetite, daily use of nutritional supplements and quality of life. RESULTS: There were 57 (89%) women and 7 (11%) men, aged 41.76 ± 7.93 years and mean postoperative period of 53.4 ± 18.4 months. The average weight and BMI were respectively 127.48 ± 24.2 kg and 49.56 ± 6.7 kg/m2 at surgery. The minimum weight and BMI were achieved 73.0 ± 18.6 kg and 28.3 ± 5.5 kg/m2, reached in 23.7 ± 12 months postoperatively. Regained significant weight occurred in 18 (28.1%) cases. The mean postoperative period of 66 ± 8.3 months and work activities related to food showed statistical significance (p=000 and p=0.003) for the regained weight. CONCLUSION: Bariatric surgery promotes adequate reduction of excess body weight, with significant weight regain observed after five years; post-operative time and work activity related to eating out as determining factors for the occurrence of weight regain.

Fatores determinantes do reganho ponderal no pós-operatório de cirurgia bariátrica / Determinants of weight regain after bariatric surgery

RACIONAL: A cirurgia bariátrica induz a uma média de perda de 60 a 75% do excesso de peso corporal, com máxima perda ponderal no período entre 18 e 24 meses de pós-operatório. Entretanto, vários estudos evidenciam que reganho ponderal ocorre a partir de dois anos da operação. OBJETIVO: Identificar fatores determinantes de reganho ponderal em usuários submetidos à cirurgia bariátrica. MÉTODOS: Estudo transversal prospectivo com 64 indivíduos submetidos à cirurgia bariátrica com tempo de pós-operatório > dois anos avaliados segundo o reganho de peso. As variáveis analisadas foram idade, sexo, escolaridade, classe econômica, atividade laboral relacionada à alimentação, tempo de pós-operatório, IMC, percentual de perda do excesso de peso, evolução ponderal, assiduidade no acompanhamento nutricional, estilo de vida, hábitos alimentares, auto-percepção do apetite, uso diário de suplementos nutricionais e qualidade de vida. RESULTADOS: Foram 57 (89%) mulheres e 7 (11%) homens, com idade de 41,76 ± 7,93 anos e tempo médio de pós-operatório de 53,4±18,4 meses. O peso e IMC médios foram, respectivamente, 127,48 ± 24,2 kg e 49,56 ± 6,7 kg/m2 no momento da operação. O peso e o IMC mínimos atingidos foram 73,0±18,6 kg e 28,3 ± 5,5 kg/m2, alcançados em 23,7±12 meses de pós-operatório. Reganho ponderal significativo ocorreu em 18 (28,1%) casos. O tempo médio de pós-operatório de 66±8,3 meses e a atividade laboral relacionada à alimentação apresentaram significância estatística (p=000 e p=0,003) para o reganho ponderal. CONCLUSÃO: A cirurgia bariátrica promove redução adequada do excesso de peso corporal, com reganho ponderal significativo observado após cinco anos; o tempo pós-operatório, a atividade laboral estimulando alimentação fora de casa foram os fatores determinantes para a ocorrência do reganho de peso.

BACKGROUND: Bariatric surgery leads to an average loss of 60-75% of excess body weight with maximum weight loss in the period between 18 and 24 months postoperatively. However, several studies show that weight is regained from two years of operation. AIM: To identify the determinants of weight regain in post-bariatric surgery users. METHODS: Prospective cross-sectional study with 64 patients who underwent bariatric surgery with postoperative time > 2 years valued at significant weight regain. The variables analyzed were age, sex, education, socioeconomic status, work activity related to food, time after surgery, BMI, percentage of excess weight loss, weight gain, attendance monitoring nutrition, lifestyle, eating habits, self-perception of appetite, daily use of nutritional supplements and quality of life. RESULTS: There were 57 (89%) women and 7 (11%) men, aged 41.76 ± 7.93 years and mean postoperative period of 53.4 ± 18.4 months. The average weight and BMI were respectively 127.48±24.2 kg and 49.56±6.7 kg/m2 at surgery. The minimum weight and BMI were achieved 73.0±18.6 kg and 28.3±5.5 kg/m2, reached in 23.7±12 months postoperatively. Regained significant weight occurred in 18 (28.1%) cases. The mean postoperative period of 66±8.3 months and work activities related to food showed statistical significance (p=000 and p=0.003) for the regained weight. CONCLUSION: Bariatric surgery promotes adequate reduction of excess body weight, with significant weight regain observed after five years; post-operative time and work activity related to eating out as determining factors for the occurrence of weight regain.