Incomplete functional reverse remodelling of the left ventricle one year after bariatric surgery. Insights from the prospective FatWest study

Background Patients with severe obesity are predisposed to development of left ventricular (LV) hypertrophy with subsequent increased myocardial oxygen demand and impaired myocardial function. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. Purpose To assess whether LV systolic function, wall mechanics, and cardiac power improve 1 year after bariatric surgery. Methods 91 severely obese patients (43±10 years, 70% women, body mass index [BMI] 41.7±4.9 kg/m2, 55% with hypertension, 17% with diabetes mellitus) underwent echocardiography before, 6 and 14 months after Roux-en-Y gastric bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV systolic function by biplane ejection fraction (EF), LV wall mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), and cardiac power normalized for LV mass by 0.222 x cardiac output x mean blood pressure (BP)/LV mass. Results Surgery induced a significant reduction in BMI, heart rate, systolic BP, and LV mass (Figure 1). Prevalence of LV hypertrophy fell from 34 to 20% 14 months after surgery (p<0.001), while that of concentric geometry remained stable: 8 vs 10% (p=0.36). GLS improved by 28%, however LV EF and MWS did not change (Figure 2). LV power at rest decreased postoperatively, reflecting the lower BP and heart rate, but was unaltered when normalized for LV mass (Figure 2). In backward stepwise multivariate regression analyses, 1 year improvement in GLS was predicted by the systolic BP reduction (p<0.05) (R2 0.73, p<0.001), while low 1-year MWS was independently associated with female gender, concentric geometry and higher myocardial oxygen demand (all p<0.01) (Nagelkerke R2 0.44, p<0.001), and lower 1-year LV power-mass with female gender and LV hypertrophy (p<0.01) (R2 0.24, p<0.001). Conclusion In severely obese patients, LV longitudinal function normalizes 1 year after bariatric surgery, mainly due to the BP reduction. LV midwall mechanics and power do not improve, especially in women and patients with persistent LV geometric abnormalities. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Cardiac Remodeling in Elite Aquatic Sport Athletes

Background: The “athlete’s heart” has been well characterized, and it is known that remodeling is dependent on the nature of the hemodynamic-stimuli. Aquatic-athletes are exposed to hydrostatic pressures, postural anomalies, and breath-holds that likely drive distinct cardiac adaptation; however, the aquatic-athlete’s heart has not been specifically interrogated. The aim of this investigation was to characterize and compare the sport-specific cardiac structure of elite aquatic-athletes. Methods: Ninety athletes at the 2019 FINA World Championships from swimming (SW:20M/17F), water-polo (WP:21M/9F), and artistic swimming (AS:23F) volunteered for echocardiographic assessment of cardiac structure. Results: Male SW displayed primarily eccentric volume-driven remodeling, while male WP had a greater incidence of pressure-driven concentric geometry (SW:5%, WP:25%) with elevated relative wall-thickness (RWT) (SW:0.35±0.04, WP:0.44±0.08, P<0.001). Female SW and WP hearts were similar with primarily eccentric-remodeling, but SW and WP had greater concentricity index than artistic swimmers (SW:6.74±1.45g/(ml)2/3, WP:6.80±1.24g/(ml)2/3, AS:5.52±1.08g/(ml)2/3, P=0.007). AS had normal geometry, but with increased posterior-wall specific RWT (SW:0.32±0.05, AS:0.42±0.11, P=0.004) and greater left atrial area than SW (SW:9.7±0.9cm2/m2, AS:11.0±1.1cm2/m2, P=0.003). All females had greater incidence of wall-thickness ≥11mm than typically reported (SW:24%, WP:11%, AS:17%). Conclusion: Male athletes presented classic sport-specific differentiation, with SW demonstrating primarily volume-driven eccentric remodelling, and WP with greater concentric geometry indicative of pressure-driven remodeling. Female SW and WP did not display this divergence, likely due to sex-differences in adaptation. AS had unique LV-specific adaptations suggesting elevated pressure under low-volume conditions. The overall incidence of elevated wall-thickness in female athletes may point to an aquatic-specific pressure stress.

Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study

Objective Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. Methods Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. Results At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). Conclusion Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. ClinicalTrials.gov https://clinicaltrials.gov/NCT01389388

Detailed finer features in spectra of interfacial waves for characterization of a bubble-laden drop

This article describes unexplored details of the intriguing spectral manifestation of the small-amplitude waves at the surfaces of a bubble-laden drop. Its natural frequencies of interfacial pulsation reveal a non-trivial variation with the position of the cavity inside the liquid. This configurational dependence of spectra is calculated for arbitrary location of the void by using a novel approach under low capillary number and low Bond number limits. The analysis is based on expansion in two sets of basis functions where their mutual transformations are utilized to enforce interfacial boundary conditions. The obtained results quantify a few important features which have both scientific and technological significance. For a concentric geometry, the inherent azimuthal degeneracy makes the frequencies for a number of vibrational modes exactly the same. For an eccentric position of the bubble, however, this degeneracy disappears, creating small deviations in the spectral values corresponding to different azimuthal modes. Such behaviour is akin to fine-structure split in an atomic system, where different quantum numbers ensure small deviation in energy levels of the states. The formulated mathematical procedure can determine the individual frequency values for the interfacial oscillation even if these are grouped closely together in bands. The paper shows how the number of fine structures inside a band and their specific values can be exploited to predict the size and position of the cavity in an opaque drop without any direct visualization of its interior.