Background: Impaired heart rate (HR) recovery after exercise testing is considered a predictor of cardiovascular mortality as it reflects vagus nerve dysfunction. Objective: To assess the relationship between body mass index (BMI) and HR recovery after exercise. Methods: We analyzed the records of 2443 patients of both sexes, aged between 20 and 59 years, in sinus rhythm, not using negative chronotropic agents and with no myocardial ischemic response to exercise testing carried out at a specialist clinic, between 2005 and 2011. BMI was categorized as normal (18.5---<25 kg/m 2 ), overweight (25---≤30 kg/m 2 ) or obese (>30 kg/m 2 ). The different BMI groups were compared in terms of HR recovery after exercise, which was calculated as the difference between maximum HR during exercise and in the first minute of recovery. Recovery was considered impaired when the difference was ≤12 bpm. Results: Eighty-seven (3.6%) patients presented impaired recovery, which was three times more prevalent in the obese group and twice as prevalent in the overweight group compared with the normal group (p<0.001 and p=0.010, respectively). Obese patients presented higher basal HR and lower maximum HR, as well as reduced chronotropic reserve (p<0.001). In multivariate analysis, impaired HR recovery was associated with overweight (relative risk [RR]=1.8; p=0.035), obesity (RR=2; p=0.016), number of metabolic equivalents (RR=0.82; p<0.001) and resting HR (RR=1.05; p<0.001). The hazard ratio for hypertension was 2 (p=0.083, NS). Conclusion: Impaired HR recovery was associated with higher BMI, demonstrating that obese individuals present vagus nerve dysfunction. Relação entre a frequência cardíaca de recuperação após teste ergométrico e índice de massa corpórea ResumoFundamento: Declínio atenuado da frequência cardíaca após teste ergométrico é considerado preditor de mortalidade cardiovascular, por refletir disfunção autonômica vagal. Objetivo: Avaliar a relação entre índice de massa corpórea (IMC) e recuperação da frequência cardíaca após teste ergométrico. Métodos: Foram incluídos registros de 2.443 pacientes de ambos os sexos, entre 20-59 anos, em ritmo sinusal, sem uso de cronotrópicos negativos e sem resposta isquêmica miocárdica ao teste ergométrico realizado em clínica especializada, entre 2005-2011. O IMC foi categorizado como: normal (18,5 kg/m 2 30 kg/m 2 ). A recuperação da frequência cardíaca após esforço, obtida pela diferença entre a máxima no esforço e no 1. • minuto da recuperação, foi comparada entre grupos de IMC. Foi considerada atenuada quando ≤12 bpm. Resultados: Oitenta e sete (3,6%) pacientes registraram recuperação atenuada, sendo três vezes maior no grupo de obesos e duas vezes no de sobrepeso, quando comparados ao grupo adequado (p<0,001, p=0,010, respectivamente). Obesos apresentaram maior frequência cardíaca basal e menor máxima, além de menor reserva cronotrópica (p<0,001). Na análise multivariada, identificou-se influência dessa atenuação po...

Objective: To study the systolic and diastolic function of asymptomatic patients with severe obesity using a Doppler echocardiography.Methods: Thirty candidates for bariatric surgery, with an average BMI of 49.2 ± 8.8 Kg/m2 and no previous history of heart disease were evaluated through transthoracic echocardiography. Results:Enlarged left chambers were observed in 42.9% of the sample, diastolic dysfunction in 54.6% and left ventricular hypertrophy in 82.1%, of which 50% of the cases presented the geometric pattern of eccentric hypertrophy. Indexation of left ventricular mass to height resulted in a significantly higher number of diagnoses for hypertrophy than indexation to body surface area (p = 0.0053), demonstrating that this index is more appropriate to determine ventricular hypertrophy in obese people. Correlations between left ventricular hypertrophy with obesity duration and pressure levels were positive as well as correlations between body mass index and diastolic dysfunction indicators. Conclusion:This study demonstrated that echocardiograms performed on asymptomatic severely obese patients can detect alterations in the cardiac structure that are common in cases of obesity cardiomyopathy and can be associated with the development of heart failure, arrhythmias and sudden death, enabling the identification of patients with greater cardiovascular risk.

SummaryObjective: Compare exercise tolerance by children and adolescents submitted to treadmill stress test (TST) following Bruce Protocol (BP) or Ramp Protocol (RP), as well as describe velocity and inclination reached with ramp protocol to help set protocol exercise standards.Methods: Observational, case-based study, with history control of 1,006 children and adolescents in the 4 to 17-yearold range who were submitted to TST between October, 1986 and February, 2003, and who concluded one of the two protocols. Those who interrupted their ET for other reasons rather than physical exhaustion, those on medication that interfered in HR and those with physical constraints to exercise were excluded. Statistical analysis of data considered p<0.05 as significance level; with confidence interval at 95%.Results: Exercise time close to 10 minutes in RP was significantly higher than in BP. HR max reached was higher than 180 bpm in both protocols. Inclination showed to be slightly higher in younger girls in Bruce Protocol. Velocity and VO 2 max showed to be higher for all age ranges for those in the Ramp Protocol. Conclusion

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SummaryObjective: Describe arterial blood pressure response in adolescents undergoing exercise stress testing.Methods: This was a cross-sectional study conducted with 218 adolescents (131 of whom were males), aged between 10 to 19 years, undergoing exercise stress testing. Maximum heart rate, total exercise time, maximum oxygen uptake, systolic blood pressure (SBP) and diastolic (DBP) at rest, during maximal physical exertion and at six minutes of recovery were measured.Results: At rest, SBP values were greater in males and no difference was found in DBP between genders, although both increased with age. During exercise, SBP rose and DBP fell in both genders. SBP variation was greater in men, particularly in those over 14 years of age.Conclusion: Analysis of results showed that during physical exercise, SBP had a direct relationship with the individual's age, weight, height and body mass index, whereas DBP bore a relationship to age only.