Effects of Bariatric Surgery on Cardiac Ectopic Fat Lesser Decrease in Epicardial Fat Compared to Visceral Fat Loss and No Change in Myocardial Triglyceride Content

ObjectivesThis study investigated the effect of bariatric surgery (BS)–induced weight loss on cardiac ectopic fat using 3T magnetic resonance imaging in morbid obesity.BackgroundHeart disease is one of the leading causes of mortality and morbidity in obese patients. Deposition of cardiac ectopic fat has been related to increased heart risk. Whether sustained weight loss can modulate epicardial fat or myocardial fat is unknown.MethodsTwenty-three morbidly obese patients underwent 1H-magnetic resonance spectroscopy to determine myocardial triglyceride content (MTGC), magnetic resonance imaging to assess epicardial fat volume (EFV), cardiac function, and computed tomography visceral abdominal fat (VAF) measurements at baseline and 6 months after BS.ResultsThe BS reduced body mass index significantly, from 43.1 ± 4.5 kg/m2 to 32.3 ± 4.0 kg/m2, subcutaneous fat from 649 ± 162 cm2 to 442 ± 127 cm2, VAF from 190 ± 83 cm2 to 107 ± 44 cm2, and EFV from 137 ± 37 ml to 98 ± 25 ml (all p < 0.0001). There was no significant change in MTGC: 1.03 ± 0.2% versus 1.1 ± 0.2% (p = 0.85). A significant reduction in left ventricular mass (118 ± 24 g vs. 101 ± 18 g) and cardiac output (7.1 ± 1.6 l/min vs. 5.4 ± 1.0 l/min) was observed and was statistically associated with weight loss (p < 0.05). The loss in EFV was limited (−27 ± 11%) compared to VAF diminution (−40 ± 19%). The EFV variation was not correlated with percentage of body mass index or VAF loss (p = 0.007). The ratio of %EFV to %VAF loss decreased with sleep apnea syndrome (1.34 ± 0.3 vs. 0.52 ± 0.08, p < 0.05).ConclusionsSix-month BS modulates differently cardiac ectopic fat deposition, with a significant decrease in epicardial fat and no change in myocardial fat. Epicardial fat volume loss was limited in patients with sleep apnea. (Impact of Bariatric Surgery on Epicardial Adipose Tissue and on Myocardial Function; NCT01284816

LA MASTOPATHIE DIABETIQUE (DES ENDOCRINOLOGIE ET METABOLISMES)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Métabolisme des glucocorticoïdes du tissu adipeux dans l'obésité et le syndrome métabolique (études chez le rat et l'homme)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Glucocorticoïdes, 11β-hydroxystéroïde déshydrogénase de type 1 et obésité viscérale

L’importance des glucocorticoïdes dans le développement et le maintien de l’obésité ainsi que la genèse de ses complications métaboliques et cardio-vasculaires est maintenant bien reconnue. L’existence, chez l’obèse, de concentrations circulantes de cortisol normales a fait envisager la possibilité d’anomalies du métabolisme local des glucocorticoïdes, en particulier dans le tissu adipeux. Un ensemble de données récentes a mis en évidence, dans ce tissu, une surexpression de la 11β-hydroxystéroïde déshydrogénase de type 1, enzyme qui convertit la cortisone (inactive) en cortisol (actif). Cette surexpression engendre un hypercorticisme local. Le développement d’inhibiteurs spécifiques de la 11β-hydroxystéroïde déshydrogénase de type 1 pourrait constituer une nouvelle approche du traitement de l’obésité viscérale et de ses complications

Expression of the mRNAs Coding for the Glucocorticoid Receptor Isoforms in Obesity

International audienc

Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure

International audienc

Evolution of Quantitative Optical Coherence Tomography Angiography Markers with Glycemic Control: A Pilot Study

International audienceAim: We aimed to analyze changes in retinal microvascularization with intensive reduction of glycated hemoglobin A1c (HbA1c) in patients with poorly controlled diabetes using quantitative optical coherence tomography angiography (OCT-A) metrics. Method: This was a retrospective observational study in patients with uncontrolled diabetes admitted to the hospital for glycemic control. A second set of 15 healthy volunteers was included to serve as a control group. OCT-A was performed at inclusion and at 3 months to measure foveal avascular zone area (FAZA), vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), acircularity index (AI), and fractal dimension (FD). Results: This analysis included 35 patients (35 eyes): 28 type-2 diabetics and 7 type-1 diabetics. Mean HbA1c was 13.1 ± 2.0% at inclusion and 7.0 ± 1.5% at 3 months. In the short period from inclusion to 3 months post-inclusion, patients showed significant decrease in VD–DCP (28.8% vs. 27.8%; p = 0.014), a significant increase in FAZA (0.300 mm2 vs. 0.310 mm2; p < 0.001), and a significant increase in AI (1.31 vs. 1.34; p < 0.01). Multivariate analysis found an increase in FAZA was correlated with baseline HbA1c level and age (R2 = 0.330), and a decrease in VD-DCP was correlated with HbA1c decrease and diabetes duration (R2 = 0.286). Conclusions: Rapid glycemic control in patients with uncontrolled diabetes led to possible short-term microvascular damage that correlated to both initial and decreased HbA1c