Effect of fitness on cardiac structure and function in overweight and obesity (the FATCOR study).

BACKGROUND AND AIMS: Obesity is associated with reduced left ventricular (LV) systolic myocardial function. We aimed to explore by means of a cross-sectional study whether this effect is offset in the presence of good fitness. METHODS AND RESULTS: We studied clinical and echocardiographic data from 469 overweight (body mass index [BMI] >27 kg/m2) and obese (BMI ≥30 kg/m2) women and men without known cardiovascular (CV) disease in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. The participants were grouped according to obesity and sex- and age adjusted peak oxygen uptake, obtained by ergospirometry. LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS) measured by speckle tracking echocardiography. The association of fitness with GLS was tested in logistic regression analyses and reported as odds ratio (OR) with 95% confidence interval (CI). In the total study population, participants were 47 years old, 60% were women, and mean BMI was 32.0 kg/m2. GLS did not differ between fit and unfit subjects within the overweight and obese groups (both p > 0.05), but the overweight fit group had higher GLS (more negative value) compared to the obese unfit group (-20.1 ± 2.6 vs. -19.0 ± 3.0, p < 0.05). In obese subjects, fitness was associated with higher GLS (OR 0.88 [95% CI 0.79-0.99, p < 0.05) in multivariable logistic regression analysis, independent of significant associations with higher arterial stiffness and lower fat percentage (all p < 0.05). In the overweight group, fitness was not significantly associated with GLS. CONCLUSION: In obesity, fitness was independently associated with higher GLS, while no association was found in overweight. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.govNCT02805478.

Weight loss facilitates reduction of left ventricular mass in obese hypertensive patients: The Campania Salute Network.

BACKGROUND AND AIMS: Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients. METHODS AND RESULTS: From the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m2.7 in women or <50 g/m2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31-93). Median weight loss was 8.6% (IQrange:6.5-12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 [95%CI 1.02-2.23], p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline. CONCLUSION: In treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.

Sex differences in subclinical cardiac disease in overweight and obesity (the FATCOR study).

BACKGROUND AND AIMS: Subclinical cardiac disease, like abnormal left ventricular (LV) geometry or left atrial (LA) dilatation, is common in obesity. Less is known about sex differences in the prevalence and type of subclinical cardiac disease in obesity. METHODS AND RESULTS: Clinical and echocardiographic data from 581 women and men without established cardiovascular disease and body mass index (BMI) > 27.0 kg/m2 participating in the FAT associated CardiOvasculaR dysfunction (FATCOR) study was analyzed. LA dilatation was recognized as LA volume indexed for height2 ≥16.5 ml/m2 in women and ≥18.5 ml/m2 in men, and abnormal LV geometry as LV hypertrophy and/or increased relative wall thickness. On average, the participants were 48 years old, 60% women and mean BMI was 32.1 kg/m2. Overall, the prevalence of subclinical cardiac disease was higher in women than men (77% vs. 62%, p < 0.001). Women had a higher prevalence of LA dilatation than men (74% vs. 56%, p < 0.001), while men had a higher prevalence of abnormal LV geometry (30% vs. 21%, p = 0.011). After adjusting for confounders in multivariable logistic regression analysis, female sex was associated with a 2-fold higher risk of subclinical cardiac disease, in particular LA dilatation (confidence interval [CI] 1.67-3.49, p < 0.001), while male sex was associated with a 2-fold higher risk of abnormal LV geometry (CI 1.30-3.01, p = 0.001). CONCLUSION: The majority of overweight and obese participants in the FATCOR study had subclinical cardiac disease, which may contribute to the impaired prognosis observed in obesity. Women had a higher prevalence of subclinical cardiac disease than men. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.govNCT02805478.

Does fitness improve the cardiovascular risk profile in obese subjects?

BACKGROUND AND AIMS: Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects. METHODS AND RESULTS: Clinical data from 491 participants in the FAT associated CardiOvasculaR dysfunction (FATCOR) study were analyzed. Physical fitness was assessed by ergospirometry, and subjects with at least good level of performance for age and sex were classified as fit. HT subtypes were identified from clinic and 24-h ambulatory blood pressure in combination. Diabetes was diagnosed by oral glucose tolerance test. MetS was defined by the American Heart Association and National Heart, Lung and Blood Institute criteria. The participants were on average 48 years old (60% women), and mean body mass index (BMI) was 32 kg/m2. 28% of study participants were classified as fit. Fitness was not associated with lower prevalences of HT or HT subtypes, diabetes, MetS or individual MetS components (all p > 0.05). In multivariable regression analysis, being fit was characterized by lower waist circumference, BMI < 30 kg/m2, non-smoking and a higher muscle mass (all p < 0.05). CONCLUSION: In the FATCOR population, fitness was not associated with a lower prevalence of major cardiovascular risk factors like HT, diabetes or MetS. Given the strong association of cardiovascular risk factor burden with risk of clinical cardiovascular disease, these findings challenge the notion that fitness alone is associated with lower risk of cardiovascular disease in obesity.

Covariates of non-dipping and elevated night-time blood pressure in ischemic stroke patients: the Norwegian Stroke in the Young Study.

Abnormal night-time blood pressure (BP) reduction is associated with increased cardiovascular risk in hypertension. Little is known about the prevalence and covariates of night-time BP reduction in ischemic stroke patients. Clinic and ambulatory BP measurements were recorded in 268 stroke survivors aged 15-60 years. The degree of night-time dipping was calculated from the difference between day-time and night-time mean BP, and defined as non-dipping if < 10%. Aortic stiffness was derived from carotid-femoral pulse-wave velocity (PWV) by applanation tonometry and carotid intima-media thickness (cIMT) by ultrasound. A non-dipping pattern was found in 38%. Non-dippers had higher PWV, mean cIMT and night-time BP, and included more patients with history of hypertension, diabetes and high for age PWV compared to dippers (all p < 0.05). In multivariate logistic regression analyses, non-dipping was associated with high for age PWV [odds ratio (OR) = 2.28; 95% confidence interval (CI) 1.06-4.92, p < 0.05] independent of history of hypertension and other confounders, while elevated night-time BP was associated with increased cIMT (OR = 3.83; 95% CI 1.01-14.50, p < 0.05) independent of non-dipping status, male gender, obesity, antihypertensive treatment and high for age PWV. In conclusion, in the Norwegian Stroke in the Young Study, non-dipping BP pattern was common and associated with increased aortic stiffness.

Brain abscess caused by paradoxical embolization in Ebstein's anomaly.

A 25-year-old woman presented with Streptococcus milleri brain abscess. Previous cardiac history was unremarkable. In search for a source of embolism echocardiography was performed and revealed a previous undiagnosed Ebstein's anomaly of moderate severity with apical displacement of the septal leaflet of the tricuspid valve and a secundum atrial septal defect (ASD) with left to right shunt. The combination of increased right atrial pressure caused by Ebstein's and an ASD with possibility of transient right to left shunt predispose for paradoxical embolization. The most likely reason for development of a brain abscess in this patient is septic embolization from an infectious focus outside the heart. Ebstein's anomaly can remain undiagnosed until adulthood if the right ventricle, in spite of the smaller size, is haemodynamically well functioning.