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.

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 ...

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