Background Obesity is a risk factor for heart failure. Surgical treatment of obesity may help prevent heart failure. Objectives We examine the effect of bariatric surgery on cardiac remodeling and function in adults with preserved left ventricular (LV) ejection fraction. Methods Thirty-eight individuals with severe obesity (body mass index ≥35 kg/m2) and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch), and 34 individuals with obesity managed medically were included. Conventional echocardiography and speckle tracking echocardiography were obtained at baseline and 12-month follow-up. Results The mean age of participants (75% female) was 48.5 ± 8.3 years and body mass index 46.4 ± 3.7 kg/m2. Bariatric surgery led to marked weight reduction (percentage of total weight loss 36.7% ± 7.1%) and significant improvements in obesity-related metabolic conditions/comorbidities. Bariatric surgery was associated with a significant reduction in LV mass and LV hypertrophy (P < 0.001), improvement in LV diastolic function parameters (P < 0.01), and improvement in subclinical systolic function (LV global longitudinal strain, 16.3% ± 2.5% vs 18.5% ± 1.3%, P < 0.05). Preoperative abnormalities of subclinical cardiac function were highly prevalent (79%) and normalized in 70% of subjects after surgery. Subjects with obesity managed medically remain with a significant burden of comorbidities and a number (38%) worsened their subclinical systolic function during the follow-up (P < 0.05). Conclusions Bariatric surgery may be an effective and safe way to prevent and/or reverse obesity-related cardiac abnormalities. Larger prospective studies are warranted to confirm these observations and determine their long-term clinical implications.

Introduction and Objective: Biliopancreatic diversion with duodenal switch(BPD/DS) surgery is the most effective approach for the management of severe obesity, but weight regain may occur in the long term. Eating behaviors in this context has not been studied. This study examines the evolution of eating behaviors at 1 year and over a 15-year period after BPD/DS in relation to weight changes. Methods: Medical history, Three Factor Eating Questionnaire/anthropometric measurement were completed at each visit. The surgery group (n=46) was assessed at baseline, at 1 and 15 years after BPD/DS. The control group (with severe obesity) was evaluated at baseline and 1 year. Long-term follow-up at 15 years conducted exclusively in the surgery group. Weight regains was defined as a weight increment ≥10% between the 1 and 15-years. Results: At baseline, the BPD/DS and control groups were similar in age, sex, weight and eating behavior. At 1 year, weight decreased significatively in the surgery group (-37.1±6.9%) compared to the control group (-0.5±5.0%). The surgery group showed a reduction in dietary disinhibition in comparison to the control group (-1.2±1.1 vs.-0.4±0.9, p=0.007). Fifteen years after surgery, 22 patients (48%) experienced weight regain of at least 10%. Patients with weight regain were younger (56±10 vs.62±9 years, p=0.06) had lower rates of hypertension (14 vs.46%, p=0.02) and type 2 diabetes (0 vs. 17%, p=0.04) than those who had maintained their weight loss. In patient who experienced weight regain, hunger increased (0.5±0.6 to 1.0±0.8, p=0.02), as did dietary disinhibition (3.1±0.3 to3.7±1.1, p=0.03), whereas both remained stable in patient without weight regain. Conclusion: BPD/DS may improve eating behaviors, notably by reducing dietary disinhibition within the first year. At 15 years, individuals with weight regain tend to be younger and show higher levels of hunger sensitivity and disinhibition. These findings suggest behavioral factors likely play an important role in long-term weight maintenance following BPD/DS. Disclosure S.S. Caroline: None. P. Poirier: None. M. Pettigrew: None. M. Piché: None. A. Auclair: None.

Weight loss in light of various weight management strategies, including bariatric surgery, is recognized to vary according to sex. This study aimed to compare sex differences in adiposity phenotypes, body fat mobilization, and obesity-associated comorbidities at baseline and after bariatric surgery. Ninety patients (26 men and 64 women) who underwent biliopancreatic diversion with duodenal switch surgery (BPD-DS) were included. Medical history, anthropometric, and bioelectrical impedance measurements as well as computed tomography scans (CT scan) were performed at baseline and at 12-month after BPD-DS. Sex differences in post-operative fat and muscle mobilization were assessed using one-way analysis of variance. At baseline, men (mean age 44.5 ± 13.2 years) presented a higher global lean mass, abdominal muscle (estimated using CT scan), a higher volume of abdominal visceral fat, and a larger proportion of mid-thigh muscle infiltrated with lipids; a proxy for ectopic fat deposition in skeletal muscle compared to women (p < 0.05 for all). After BPD-DS, there were no differences in fat distribution between sexes, except for abdominal fat volume and muscle infiltrated with lipids which remained higher in men (p < 0.05). These differences translated into a numerically non-significant lower rate of remission of comorbidities in men. Our result reports on sex differences in body fat mobilization at 12 months post-BPD-DS. Despite comparable body mass index and overall lean and fat mass, men exhibit a higher volume of abdominal fat volume and greater ectopic fat deposition in skeletal muscles compared to women.

Introduction and Objective: Bariatric surgery is an effective treatment for severe obesity but causes muscle mass and strength loss. Physical activity may help counteract these effects, but its impact post-surgery is unclear. This study examined the effects of a 12-week supervised exercise program on muscle mass and strength after bariatric surgery. Methods: This trial included 60 patients who underwent either biliopancreatic diversion with duodenal switch or sleeve gastrectomy. They were assigned to an exercise group (aerobic and resistance training, 3 times/week) or a standard care group. Body composition and maximal isometric strength were measured pre-surgery and at 3, 6, and 12 months post-surgery. Results: The analysis included 50 participants (73% female, mean age 42 years, BMI 45.8 kg/m²). Bariatric surgery significantly reduced anthropometric parameters (BMI, body fat and lean mass) at 3, 6, and 12 months (p<0.001), with no differences between groups (p > 0.05). Maximal isometric strength declined comparably (-9.0 vs -7.3%, p=0.65), as did the strength-to-weight ratio (p = 0.93). At 12 months, BMI and body composition remained comparable (p > 0.05). Muscle strength continued to decrease similarly (-12.0 vs. -13.8%, p = 0.72), while the strength-to-weight ratio increased in both groups (p = 0.54). Conclusion: A 12-week exercise program after bariatric surgery has not proven more effective than standard care in preserving muscle mass and strength. Additional research is required to investigate alternative exercise approaches in order to identify optimal strategies to enhance patient recovery and fitness in terms of muscle strength preservation. C.S. Samhani: None. F. Lajeunesse-Trempe: None. A. Auclair: None. P. Poirier: None. M. Piché: None.

Background/Objectives: Hypertensive response to exercise (HRE) is an established risk factor for cardiovascular events. HRE is prevalent among people with excess adiposity. Both obesity and HRE have been individually associated with adverse cardiac remodeling. We hypothesized that HRE would be associated with adverse measures of cardiac structure and function in a subgroup of individuals with abdominal obesity. Methods: In a subgroup of 158 participants with elevated waist circumference (women: ≥80 cm, men: ≥94 cm) and resting blood pressure (BP) < 140/90 mm Hg, we evaluated maximal exercise BP and peak oxygen consumption (VO2peak) during cardiorespiratory exercise testing. HRE was defined as maximal exercise BP ≥ 90th percentile per sex and age. Cardiac structure and function on echocardiography were compared between HRE and no HRE (NHRE) groups for each sex. Multivariate linear regression was used to evaluate associations between maximal systolic BP (SBP) and echocardiographic variables, adjusting for age, body mass index, resting SBP, and VO2peak. Results: Participants (75% women) were aged 53 ± 11 years old. Women with HRE had higher resting SBP and subclinical cardiac remodeling abnormalities (increased left ventricular [LV] wall thickness, relative wall thickness, and mass) than NHRE women (p < 0.05). Men with HRE had higher relative wall thickness than NHRE men (p = 0.042). There was no difference in cardiac function between HRE groups (p > 0.05). After adjustment, maximal SBP remained associated with adverse cardiac remodeling parameters for each sex (p < 0.05). Conclusions: Among individuals with abdominal obesity and resting BP < 140/90 mm Hg, HRE was associated with adverse cardiac remodeling. HRE represents a potential screening tool and preventive target to detect those at higher risk of preclinical cardiac changes.

Background: We aimed to determine whether the addition of yoga to a regular exercise training regimen improves cardiometabolic risk profile.Methods: Sixty individuals with diagnosed hypertension (> 140/90 mm Hg for 3 measurements on different days) were recruited in an exercise training program. In addition to aerobic exercise training, participants were randomised into either a yoga or a stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid levels as well as the Framingham and Reynolds Risk Scores were measured.Results: At baseline, there was no difference in age, sex, smoking status, body mass index, blood pressure, heart rate, lipid and glucose levels, and Framingham Risk Score between groups. After the 3-month intervention period, the decrement in systolic and diastolic blood pressures (before vs after stretching: 126 +/- 11/76 +/- 7 vs 122 +/- 11/73 +/- 8 mm Hg; before vs after yoga: 130 +/- 13/77 +/- 10 vs 119 +/- 11/69 +/- 8 mm Hg) and heart rate was greater (P < 0.001) in the yoga group, with similar decreases in lipid, glucose, and hs-CRP levels and Framingham Risk Score in both groups. Reynolds Risk Score decrement was higher in the yoga vs the control group (ab-solute reduction-1.2 +/- 1.2 vs-0.6 +/- 0.8; relative reduction 13.2 +/- 11.8% vs 9.3 +/- 6.5%; P < 0.05).Conclusion: In patients with hypertension, the practice of yoga incor-porated in a 3-month exercise training program was associated with greater improvement in resting blood pressure and heart rate and Reynolds Risk Score compared with stretching.

BACKGROUND:Management of aortic stenosis (AS) relies on symptoms. Exercise testing is recommended for asymptomatic patients with significant AS but is often experienced as forbidding and/or technically unrealistic for patients who are often frail, deconditioned, and intimidated by the exercise test. We compared the physiological burden assessed with gas exchange assessments to gauge and respiratory exchange ratio (RER) of a 6-minute walk test (6MWT) to a cardiopulmonary exercise stress test (CPET) in patients with severe AS. peak oxygen utilization.METHODS:Adults with equivocal symptoms and severe AS (1-aortic valve area [AVA] ≤ 1.0 cm2 or AVA index ≤ 0.6 cm2/m2, 2-peak aortic jet velocity ≥ 4.0 m/sec, 3-mean transvalvular pressure gradient ≥ 40 mm Hg by rest or dobutamine stress echocardiography, or 4-aortic valve calcification ≥ 1200 in women or ≥ 2000 AU in men) were studied. All participants completed both a 6MWT and symptom-limited progressive bicycle exercise testing. Breath-by-breath gas analysis and 12-lead electrocardiography were completed during 6MWT and CPET. Results: Eleven patients were studied. Patients walked on average 330 ± 75 m during the 6MWT and achieved a maximal workload of 48 ± 14 watts during the CPET. During the 6MWT, peak maximal oxygen uptake ( V ˙ O2peak) was 12.8 ± 2.5 vs 10.8 ± 4.2 mL/kg/min during the CPET. Respiratory exchange ratio exceeded 1.1 in both the 6MWT and CPET indicating similarly high exertion. Compared with the CPET, a larger proportion of the 6MWT was performed at a high intensity level (78% ± 28% vs 33% ± 24% at > 85% V̇O2peak; P = 0.004).CONCLUSIONS:The 6MWT with breath-by-breath gas analysis was well tolerated and able to achieve a physiological intense RER and V ˙ O2peak that are similar to symptom-limited CPET in patients with severe AS.

Background: Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgerye induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery. Methods: Fifty-eight severely obese patients (46.1 +/- 6.1 kg/m(2), 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery. Results: Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (VO2peak) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 +/- 4.2 to 23.2 +/- 5.7 mL/kg/min; control group: from 17.4 +/- 2.3 to 19.7 +/- 2.4 mL/kg/min; P value, group x time = 0.01). In the exercise group, determinants of absolute VO2peak (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r(2) = 0.92; P < 0.0001), whereas determinants of VO2peak indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r(2) = 0.70; P < 0.0001). Conclusions: A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery.

Most patients with severe obesity will present some lipid-lipoprotein abnormalities. The atherogenic dyslipidemia associated with severe obesity is characterized by elevated fasting and postprandial triglyceride levels, low high-density lipoprotein cholesterol concentrations, and increased proportion of small and dense low-density lipoproteins. Bariatric surgery has been proven safe and successful in terms of long-term weight loss and improvement in obesity co-existing metabolic conditions including lipid-lipoprotein abnormalities. Nevertheless, bariatric surgery procedures are not all equivalent. We conducted a comprehensive critical analysis of the literature related to severe obesity, bariatric surgery and lipid-lipoprotein metabolism/profile. In this review, we described the metabolic impacts of different bariatric surgery procedures on the lipid-lipoprotein profile, and the mechanisms linking bariatric surgery and dyslipidemia remission based on recent epidemiological, clinical and preclinical studies. Further mechanistic studies are essential to assess the potential of bariatric/metabolic surgery in the management of lipid-lipoprotein abnormalities associated with severe obesity. Understanding the beneficial effects of various bariatric surgery procedures on the lipid-lipoprotein metabolism and profile may result in a wider acceptance of this strategy as a long-term metabolic treatment of lipid-lipoprotein abnormalities in severe obesity and help clinician to develop an individualized and optimal approach in the management of dyslipidemia associated with severe obesity. BRIEF SUMMARY: Abnormal lipid-lipoprotein profile is frequent in patients with severe obesity. Significant improvements in lipid-lipoprotein profile following bariatric surgery occur early in the postoperative period, prior to weight loss, and persists throughout the follow-up. The mechanisms that facilitate the remission of dyslipidemia after bariatric surgery, may involve positive effects on adipose tissue distribution/function, insulin sensitivity, liver fat content/function and lipid-lipoprotein metabolism.

Aims We explored the early effects of bariatric surgery on subclinical myocardial function in individuals with severe obesity and preserved left ventricular (LV) ejection fraction. Methods Thirty-eight patients with severe obesity [body mass index (BMI) ≥35 kg/m2] and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch [BPD-DS]) (Surgery group), 19 patients with severe obesity managed with usual care (Medical group), and 18 age and sex-matched non-obese controls (non-obese group) were included. Left ventricular global longitudinal strain (LV GLS) was evaluated with echocardiography speckle tracking imaging. Abnormal myocardial function was defined as LV GLS <18%. Results Age of the participants was 42 ± 11 years with a BMI of 48 ± 8 kg/m2 (mean ± standard deviation); 82% were female. The percentage of total weight loss at 6 months after bariatric surgery was 26.3 ± 5.2%. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced postoperatively. Before surgery, patients with obesity displayed abnormal subclinical myocardial function vs. non-obese controls (LV GLS, 16.3 ± 2.5 vs. 19.6 ± 1.7%, P < 0.001). Six months after bariatric surgery, the subclinical myocardial function was comparable to non-obese (LV GLS, 18.2 ± 1.9 vs. 19.6 ± 1.7%, surgery vs. non-obese, P = NS). On the contrary, half of individuals with obesity managed medically worsened their myocardial function during the follow-up (P = 0.002). Improvement in subclinical myocardial function following bariatric surgery was associated with changes in abdominal visceral fat (r = 0.43, P < 0.05) and inflammatory markers (r = 0.45, P < 0.01), whereas no significant association was found with weight loss or change in insulin sensitivity (HOMA-IR) (P > 0.05). In a multivariate model, losing visceral fat mass was independently associated with improved subclinical myocardial function. Conclusions Bariatric surgery was associated with significant improvement in the metabolic profile and in subclinical myocardial function. Early improvement in subclinical myocardial function following bariatric surgery was related to a greater mobilization of visceral fat depot, linked to global fat dysfunction and cardiometabolic morbidity.

Background Exaggerated blood pressure response to exercise is a cardiovascular risk factor associated to higher morbidity and mortality. Severely obese patients have an increased risk of exercise-induced hypertension (EIH). We aimed to assess the blood pressure response to exercise in patients with severe obesity who underwent bariatric surgery as well as the main determinants of this response. Methods We used data from the ACTIVE clinical trial, in which 60 severely obese patients who underwent bariatric surgery were enrolled. Anthropometric measurements, abdominal and mid-thigh computed tomography scans and maximal exercise testing were performed before bariatric surgery, as well as 3 and 6 months post-surgery. EIH was defined as a maximal SBP ≥210 mmHg for men and ≥190 mmHg for women. Results At baseline, 62% of patients had EIH. At 6 months, we observed an EIH resolution rate of 39%. The main determinant of EIH resolution was sex. Actually, patients with EIH resolution were mostly women without resting hypertension and a lower amount of visceral adipose tissue. Conclusion These results suggest that bariatric surgery is efficient to resolve EIH, particularly in women with initially a better anthropometric profile.

Elevated lipoprotein(a) (Lp(a)) level is an independent risk factor for cardiovascular diseases. Lifestyle intervention studies targeting weight loss revealed little to no significant changes in Lp(a) levels. The impact of interventions that induce substantial weight loss, such as bariatric surgery, on Lp(a) levels is currently unclear. To determine the acute and long-term impact of bariatric surgery on Lp(a) levels in patients with severe obesity. Sixty-nine patients with severe obesity underwent biliopancreatic diversion with duodenal switch (BPD-DS) surgery. The lipid profile was evaluated and Lp(a) levels were measured before surgery and at 6 and 12 months after BPD-DS surgery. Median Lp(a) levels at baseline were 11.1 (4.1–41.6) nmol/L. Six months and 12 months after the BDP-DS surgery, we observed an improvement of lipid profile. At 6 months, we observed a 13% decrease in Lp(a) levels (9.7 (2.9–25.6) nmol/L, p < 0.0001) but this decrease was not sustained at 12 months (11.1 (3.9–32.8) nmol/L, p = 0.8). When the patients were separated into tertiles according to Lp(a) levels at baseline, we observed that the Lp(a) reduction at 12 months after BPD-DS surgery remained significant but modest in patients of the top Lp(a) tertile. Our results suggest that BPD-DS surgery modestly reduces Lp(a) levels in the short term (6 months) in patients with severe obesity but this improvement is sustained over time only in patients with higher Lp(a) levels.

The benefit of exercise training on lipid profile in bariatric surgery patients is scarce. We assess the effect of a supervised exercise-training program on lipid profile following bariatric surgery. A total of 60 patients were prospectively recruited, of those 49 completed the study (age 41 ± 11 years; body mass index 45.9 ± 6.1 kg/m2, 75% women). The bariatric surgery procedures performed were sleeve gastrectomy (SG) (n = 24) and biliopancreatic diversion with duodenal switch (BPD-DS) (n = 25). Of the 49 patients who completed the study, 34 had been randomized to a 12-week supervised exercise training program (exercise group) between the 3rd and the 6th month following bariatric surgery (SG = 17 and BPD-DS = 17). Fasting blood samples and anthropometric measurements were performed preoperatively and at 3, 6, and 12 months after bariatric surgery. At 6 months and 12 months, percentage of weight loss was similar between groups (6 months: − 29.6 ± 5.5 vs. − 27.8 ± 7.7%; P = 0.371; 12 months: − 38.4 ± 10.4 vs. − 37.9 ± 9.5%; P = 0.876 exercise vs. control). Both groups had an increase in HDL values between the 3nd and the 6th month following bariatric surgery. There was a significantly greater increment in HDL values in the exercise group (0.18 ± 0.14 vs. 0.07 ± 0.12 mmol/L, P = 0.014; exercise vs. control). Our results showed a beneficial effect of a 12-week supervised exercise-training program in bariatric surgery patients showing similar weight loss on HDL-cholesterol levels without additional effect on LDL-cholesterol levels.

BACKGROUND:Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited. OBJECTIVES:To measure and compare the changes in fat-free mass with the changes in muscle composition after biliopancreatic diversion with duodenal switch surgery (BPD/DS). SETTING:Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited. METHODS:Forty patients underwent BPD/DS and 22 patients are considered as controls. Bioelectrical impedance analysis (body composition) and computed tomography scan at the midthigh and abdominal levels (muscle composition) were performed at baseline, 6, and 12 months. RESULTS:At 6 and 12 months, the BPD/DS group displayed significant reduction in weight (12 months: -46.6 ± 13.5 kg) and fat-free mass (12 months: -8.2 ± 4.4 kg; both P < .001). A significant reduction in abdominal (-15 ± 8%, P < .001) and midthigh muscle areas (-18 ± 7%, P < .001) was observed during the first postoperative 6 months, followed by a plateau after 6 months (abdominal: -1 ± 5%, midthigh: -1 ± 4%, both P > .05). At 6 months, both midthigh fat-infiltrated muscle (-22 ± 10%, P < .001) and normal-density muscle (-16 ± 9%, P < .001) areas decreased. Further reduction at 12 months was only observed in the fat-infiltrated muscle (-11 ± 8%, P < .001) in comparison with an increase in the normal-density muscle area (5 ± 8%, P = .001). There was no significant change for the control group. CONCLUSIONS:Reduction in muscle, assessed with computed tomography scans, occurs mostly during the first 6 months postoperatively after BPD/DS. Focus on muscle quantity as well as quality, using precise imaging methods, instead of quantifying total body lean mass, is likely to provide better assessment in body content modulation after BPD/DS.

Autotaxin (ATX), an adipose tissue-derived lysophospholipase, has been involved in the pathophysiology of cardiometabolic diseases. The impact of bariatric surgery on circulating ATX levels is unknown. We examined the short- (24 h, 5 days) and longer-term (6 and 12 months) impact of bariatric surgery; as well as the short-term effect of caloric restriction (CR) on plasma ATX levels in patients with severe obesity. We measured ATX levels in 69 men and women (mean age: 41 +/- 11 years, body mass index: 49.8 +/- 7.1 kg/m(2)), before and after biliopancreatic diversion with duodenal switch surgery (BPD-DS) as well as in a control group (patients with severe obesity without surgery; n = 34). We also measured ATX levels in seven patients with severe obesity and type 2 diabetes who underwent a 3-day CR protocol before their BPD-DS. At baseline, ATX levels were positively associated with body mass index, fat mass, insulin resistance (HOMA-IR) as well as insulin and leptin levels and negatively with fat-free mass. ATX concentrations decreased 26.2% at 24 h after BPD-DS (342.9 +/- 152.3 pg/mL to 253.2 +/- 68.9 pg/mL, P < 0.0001) and by 16.4% at 12 months after BPD-DS (342.9 +/- 152.3 pg/mL to 286.8 +/- 182.6 pg/mL, P = 0.04). ATX concentrations were unchanged during follow-up in the control group (P = 0.4), and not influenced by short-term CR. In patients with severe obesity, bariatric surgery induced a rapid and sustained decrease in plasma ATX levels. Acute changes in ATX may not be explained by bariatric surgery-induced CR.

Introduction: Heart rate variability (HRV) is a recognized cardiovascular prognostic factor as reduced HRV is associated with adverse cardiovascular events. Interestingly, studies have demonstrated...

BACKGROUND Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in different arm positions. METHODS Thirty-three severely obese patients and 21 controls participated in the study. Pairs of intra-arterial blood pressures were compared with simultaneous forearm blood pressure measurement using an oscillometric device in 4 positions: (i) supine, (ii) semi-fowler with the forearm resting at heart level, (iii) semi-fowler with the arm downward, and (iv) semi-fowler with the arm raised overhead. Degree of agreement between measurements was assessed. RESULTS Overall, correlations of systolic and diastolic blood pressure measurements between the gold standard and forearm blood pressure were 0.95 (n = 722; P < 0.001) and 0.89 (n = 482; P < 0.001), respectively. Systolic blood pressure measured using the forearm approach in the supine and the semi-fowler positions with arm downward showed the best agreement when compared with the gold standard (-4 ± 11 (P < 0.001) and 2 ± 14 mm Hg (P = 0.19), respectively). In the control group, better agreement was found between the supine and semi-fowler positions with the arm resting at heart level (1 ± 9 mm Hg (P = 0.29) and -3 ± 10 mm Hg (P = 0.01), respectively). CONCLUSIONS Forearm systolic blood pressure consistently agreed with the gold standard in the supine position. This method can be of use in clinical settings when upper-arm measurement is challenging in severe obesity.

Safety of exercise training in relationship with the risk of hypoglycemia post-bariatric surgery is unknown.

The lack of spectroscopic measurements for rare CO2 isotopologues was the main motivation of this work. In our present study we report line intensity measurements for 16O12C17O made with a high resolution Fourier transform spectrometer (Bruker IFS-125HR) and a 21 m path cryogenic Herriott cell at Jet Propulsion Laboratory. For this, a 17O-enriched CO2 gas sample was used, which comes as a mixture of primary and several minor CO2 isotopologues. The mole fraction of the 16O12C17O isotopologue in the mixture was determined to be 0.3991 by mass spectrometry from a Stable Isotope Ratio Mass Spectrometer (SIRMS) under stochastic distribution assumption at thermal equilibrium. Since the collisional narrowing effect was observed, the Rautian molecular line shape profile was systematically adopted instead of the Voigt profile. Absolute line positions were also investigated by performing a wavenumber calibration based on CO, HCl and a few well-known 16O12C16O transitions. Finally, around 1000 transitions were studied between 4604 and 5126 cm−1 involving 15 bands of the 16O12C17O isotopologue. All the measured line intensities were renormalized to be the values for 100% pure isotopologue sample. Transition dipole moments and Herman-Wallis factors were derived enabling a global comparison with theoretical calculations and predictions for the 15 bands of the 16O12C17O isotopologue. For the measured line positions, the absolute accuracy is around 2×10−4 cm−1. The accuracies of retrieved line intensities are 2 – 5% for five cold and two hot bands, and 6–30% for eight other weaker hot bands. Results from this work were in a good agreement with HITRAN 2012 for positions, but showed rather significant discrepancies for line intensities. An extensive line list was generated from new experimental measurements in order to improve and validate spectroscopic knowledge of 12C16O17O isotopologue in support of atmospheric remote sensing for the Earth (e.g., OCO-2 mission), Mars and Venus.

Introduction: Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.