SummaryObesity and the metabolic syndrome (MetS) are risk factors for left ventricular diastolic dysfunction (LVDD). However, little is known about the impact of successful weight reduction (WR) on diastolic function and physical performance.Obese subjects (øBMI 40.2 ± 8.6 kg/m 2 ) underwent a 1-year WR program comprising diet and lifestyle components. Echocardiography and exercise capacity (6-minute walk) were performed at baseline and after 1 year. The distribution of weight reduction was split at the sample median and subjects were dichotomized in "successful WR" (% WR ≥ median, corresponding to a weight loss of 8%) and "failed-WR" (% WR < median).From a total of 188 obese subjects, 71 had LVDD at baseline. Obese patients with successful WR improved their MetS alterations, including fasting glucose, insulin, lipids, adipokines, blood pressure levels, and epicardial fat thickness. (-28 [-54, -4], P < 0.01), and 6-minute walk distance (65 [19, 135], P < 0.01). Improvement of ≥ 2 LVDD criteria was accomplished in 30% of subjects with WR versus 10% without (P = 0.009). Using multivariable regression analysis, reduction of epicardial fat thickness was particularly predictive for the improvement of diastolic function.In summary, in severe obesity, successful long-term WR was associated with improved LV diastolic function and exercise capacity. (Int Heart J 2015; 56: 196-202) Key words: Adiposity, Metabolic syndrome, Diastolic dysfunction, Weight loss O besity and metabolic syndrome (MetS) are increasing in global prevalence. Accompanying these trends there is a concerning shift in the population weight distribution toward the more extreme ends of obesity, given an increased risk for cardiovascular morbidity and mortality that is associated with excess adiposity.1-4) One associated finding is an impairment of cardiac performance leading to myocardial systolic and diastolic dysfunction and clinical symptoms often indistinguishable from heart failure. In fact, evidence of left ventricular diastolic dysfunction (LVDD) is a common finding in the obese, and consequently, obesity is considered a risk factor for diastolic heart failure. 5-9)Although lifestyle modification and weight reduction are routinely recommended to improve symptoms and to reduce cardiovascular risk in the obese with metabolic disorders, their effects on diastolic function and physical performance have been studied only rudimentarily, particularly in adults with severe obesity. Thus, the aim of the present study was to assess the effect of long-term lifestyle and weight reduction programs on these measures in severely obese subjects with varying degrees of MetS.Notably, there is considerable variation in biological determinants, encompassing metabolic and endocrine factors and in the degree of weight loss per se achieved by individuals in response to caloric restriction and physical activity. 10,11) In this regard, it is of interest that several of these biological determinants may independently influence diastolic function or modify the effect of...

Objectives:This study aimed to examine the association of adipocyte fatty acid-binding protein (FABP4) levels with left ventricular diastolic dysfunction (LVDD) in obese subjects with varying degrees of the metabolic syndrome (MetS).Methods:Fifty morbidly obese subjects with LVDD were selected at random and matched by age (±5 years) and sex with 50 morbidly obese with normal left ventricular (LV) function. In addition, 24 healthy lean subjects were included as controls.Results:Median FABP4 levels (interquartile range) in obese subjects with LVDD were significantly higher (42 ng ml−1 (32–53)) than in obese with normal LV function (24 ng ml−1 (36–43), P=0.036), and in normal weight controls (13 ng ml−1 (10–20), P<0.0001). Increasing FABP4 tertiles were significantly associated with parameters of LVDD, the number of LVDD components, physical performance and epicardial fat thickness. In multivariate regression analysis adjusting for age, sex and adiposity, FABP4 levels remained significantly associated with parameters of diastolic function. The association of FABP4 levels with LVDD was mainly observed in subjects with metabolic complications, but not in metabolically healthy obese.Conclusions:FABP4 levels are significantly associated with LVDD in obese subjects, when the MetS is present. Thus, FABP4 may be a link between obesity and cardiometabolic disorders.

AimsThis study aimed to examine the incremental value of growth-differentiation factor-15 to N-terminal pro brain natriuretic hormone (NT-proBNP) levels for the diagnosis of left ventricular diastolic dysfunction (LVDD) and possible heart failure (HF) in morbidly obese patients. Method and resultsWe analysed data from 207 obese subjects [body mass index (BMI) 41 + 8 kg/m 2 ] with normal ejection fraction, LVDD, and symptoms and/or signs of HF (referred to as 'LVDD with possible HF', n ¼ 88) and with normal left ventricular function (n ¼ 119) before participating in a medical weight loss programme, in addition to the study of healthy lean subjects (n ¼ 51). Median NT-proBNP (interquartile range) for obese subjects with 'LVDD and possibe HF' and with normal LV function was 52 (29 -96) and 42 (25-66) pg/mL, respectively (P ¼ 0.12). There was no correlation of NT-proBNP with parameters of left ventricular filling pressure, i.e. E/E' (r 2 ¼ 0.002, P ¼ 0.63) or E' velocity (r 2 ¼ 0.02, P ¼ 0.24). In contrast, GDF-15 was 665 (496 -926) with 'LVDD and possible HF ' and 451 (392 -679) pg/mL without (P , 0.0001). GDF-15 was significantly correlated to E/E', E' velocity, E/A ratio, isovolumetric relaxation time, duration of reversed pulmonary vein atrial systolic flow, and left atrial size. The area under the receiver operating characteristic curve that defines LVDD with possible HF was 0.56 for NT-proBNP and 0.74 for GDF-15 (P , 0.0001). The addition of GDF-15 to a multivariate predicition model increased the net reclassification improvement (NRI) by 9% (P¼ 0.022). ConclusionIn morbidly obese individuals, GDF-15 levels seem to better correlate with diastolic dysfunction than NT-proBNP levels. GDF-15 significantly improves reclassification for the diagnosis of 'LVDD with possible HF' and, thus, adds incremental value to NT-proBNP.--

SummaryThis study sought to examine the relationships between right ventricular (RV) function and geometry, morbid obesity with and without the metabolic syndrome, and the effect of long-term weight loss. Obese (n = 153, BMI 41.2 ± 8.7 kg/m 2 ) and healthy non-obese control subjects (n = 38, BMI 25.5 ± 3.3 kg/m 2 ) of similar age and gender distribution were prospectively studied during the course of a 1-year weight reduction program with echocardiography at baseline and after one year of follow up. Function and geometry of the right heart were evaluated by tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TDI S'), RV myocardial performance index (TEI), RV end-diastolic (RVEDD) and end-systolic diameter (RVESD), area of the right atrium (RAA), and systolic pulmonary artery pressure (PAP). Whereas parameters of systolic and diastolic LV function were significantly worse in the obese subjects than those in the non-obese subjects (EF 66 ± 6 versus 69 ± 6%, P = 0.004; E/E' 7.4 ± 2.5 versus 6.3 ± 2.6, P = 0.010), parameters of RV function (TAPSE 25.6 ± 4.5 versus 25.1 ± 3.5 mm, P = 0.528; TDI S' 13.5 ± 2.9 versus 13.8 ± 2.9 mm/second, P = 0.553; TEI 0.25 ± 0.13 versus 0.28 ± 0.09, P = 0.283) as well as geometry measurements were comparable between the obese and non-obese participants and also in obese subjects with full blown metabolic syndrome. Additionally, successful weight reduction did not alter the RV parameters. Nevertheless, in the few obese subjects with RV dysfunction (n = 7), metabolic syndrome parameters were more pronounced than in obese with normal RV function.Morbid obesity with and without the metabolic syndrome is accompanied by an impaired LV systolic and diastolic function. In contrast, RV function appears to be less affected by obesity independent of the presence of the metabolic syndrome. (Int Heart J 2016; 57: 441-448) Key words: Adiposity, Heart failure, Echocardiography O besity and the metabolic syndrome are fast-growing disorders in western countries which are associated with variant cardiovascular abnormalities leading to a high risk of cardiovascular morbidity and mortality.1) The Framingham Heart Study demonstrated a 2-fold higher risk of developing heart failure in obese subjects with a body mass index ≥ 30 kg/m 2 in comparison to non-obese ones in a large community-based sample.2) Moreover, adiposity was described as an independent risk factor for developing heart failure with a population attributable risk of 8.0% in a large prospective cohort study with a follow-up of 19 years. 3)Adiposity results in different subclinical changes in cardiac function.1) Arterial hypertension, impaired glucose tolerance, dyslipidemia, altered hemodynamics, elevation of neurohumoral and inflammatory markers, prothrombotic state, and obstructive sleep apnea are associated conditions which may further predispose to heart failure. [2][3][4] While the influence of obesity on left ventricular (LV) function is understood in more detail, such as the correlation of body ...

Some years ago, Nidek developed a new imaging system for the anterior eye segment, which offers the possibility of recording Scheimpflug and retroillumination images. The system consists of 2 different technical units, a camera unit for image recording and a computer unit for storage, system operation and image analysis. To evaluate the clinical use of the system and its reproducibility, a study with 31 volunteers/patients was performed that were photographed with the Nidek EAS 1000 at the meridians 0°, 45° and 180°. Two examinations with a 1-week interval were performed. In addition, a direct comparison of the EAS 1000 with the Topcon SL-45 was carried out with 32 volunteers that were photographed at 0° and 45°; a retroillumination photo was additionally recorded. The video images were evaluated with the computer software, the SL-45 negatives were standardly measured with a Joyce-Loebl densitometer. The handling of the EAS 1000 in clinical use was found to be easy and comfortable for the patient, as the alignment is done with infrared light. Difficulties occur only with the retroillumination photography in that the infrared light for imaging may outshine the red fixation light during exposure. However, shadowing problems due to the eyelashes occur in oblique slit positions, especially in those patients with a pronounced front head. In studying the reproducibility, the mean values of the individual coefficients of variation for light scattering (density) were in a range between 3.6 and 5.06%, but more than 35% of the single values show a variation coefficient above 5% (maximum 20.3%). In a direct comparison of the 2 systems, the SL-45 still has its advantages, but the EAS 1000 with its video imaging technique can become the system of the future, after several improvements in hard- and software have been made.