Validation of the individualized metabolic surgery score for bariatric procedure selection in the merged data of two randomized clinical trials (SLEEVEPASS and SM-BOSS).

Background: LSG and LRYGB are globally the most common bariatric procedures. IMS score categorizes T2D severity (mild, moderate, and severe) based on 4 independent preoperative predictors of long-term remission as follows: T2D duration, number of diabetes medications, insulin use, and glycemic control. IMS score has not been validated in a randomized patient cohort.Objectives: To assess the feasibility of individualized metabolic surgery (IMS) score in facilitating procedure selection between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for patients with severe obesity and type 2 diabetes (T2D).Setting: Merged individual patient-level 5-year data of 2 large randomized clinical trials (SLEEVEPASS and SM-BOSS [Swiss Multicenter Bypass or Sleeve Study]).Methods: IMS score was calculated for study patients and its performance was analyzed.Results: One hundred thirty-nine out of 155 patients with T2D had available preoperative data to calculate IMS score as follows: mild stage (n = 41/139), moderate stage (n = 77/139), severe stage (n = 21/139). At 5 years, 135 (87.1%, 67 LSG/68 LRYGB) were available for follow-up and 121 patients had both pre- and postoperative data. Diabetes remission rates according to preoperative IMS score were as follows: mild stage 87.5% (n = 14/16) after LSG and 85.7% (n = 18/21) after LRYGB (P = .999), moderate stage 42.9% (n = 15/35) and 45.2% (n = 14/31) (P = .999), and severe stage 18.2% (n = 2/11) and 0% (n = 0/7) (P = .497), respectively. The T2D remission rate varied significantly between the stages as follows: mild versus moderate odds ratio (OR) 8.3 (95% CI, 2.8-24.0; P Conclusions: In our study, remission rates of T2D were not statistically different after LSG and LRYGB among all patients and among patients with mild, moderate, and severe diabetes stratified by the IMS score. However, the study may be underpowered to detect differences due to small number of patients in each subgroup. IMS score seemed to be useful in predicting long-term T2D remission after bariatric surgery.</p

Accuracy of echocardiographic area-length method in chronic myocardial infarction : comparison with cardiac CT in pigs

Abstract Background We evaluated echocardiographic area-length methods to measure left ventricle (LV) volumes and ejection fraction (EF) in parasternal short axis views in comparison with cardiac computed tomography (CT) in pigs with chronic myocardial infarction (MI). Methods Male farm pigs with surgical occlusion of the left anterior descending coronary artery (n = 9) or sham operation (n = 5) had transthoracic echocardiography and cardiac-CT 3 months after surgery. We measured length of the LV in parasternal long axis view, and both systolic and diastolic LV areas in parasternal short axis views at the level of mitral valve, papillary muscles and apex. Volumes and EF of the LV were calculated using Simpson’s method of discs (tri-plane area) or Cylinder-hemiellipsoid method (single plane area). Results The pigs with coronary occlusion had anterior MI scars and reduced EF (average EF 42 ± 10%) by CT. Measurements of LV volumes and EF were reproducible by echocardiography. Compared with CT, end-diastolic volume (EDV) measured by echocardiography showed good correlation and agreement using either Simpson’s method (r = 0.90; mean difference −2, 95% CI −47 to 43 mL) or Cylinder-hemiellipsoid method (r = 0.94; mean difference 3, 95% CI −44 to 49 mL). Furthermore, End-systolic volume (ESV) measured by echocardiography showed also good correlation and agreement using either Simpson’s method (r = 0.94; mean difference 12 ml, 95% CI: −16 to 40) or Cylinder-hemiellipsoid method (r = 0.97; mean difference:13 ml, 95% CI: −8 to 33). EF was underestimated using either Simpson’s method (r = 0.78; mean difference −6, 95% CI −11 to 1%) or Cylinder-hemiellipsoid method (r = 0.74; mean difference −4, 95% CI–10 to 2%). Conclusion Our results indicate that measurement of LV volumes may be accurate, but EF is underestimated using either three or single parasternal short axis planes by echocardiography in a large animal model of chronic MI

[F-18]FDG Accumulation in Early Coronary Atherosclerotic Lesions in Pigs

We found increased uptake of [F-18]FDG in coronary atherosclerotic lesions in a pig model. However, uptake in these early stage lesions was not detectable with in vivo PET imaging. Further studies are needed to clarify whether visible [F-18]FDG uptake in coronary arteries represents more advanced, highly inflamed plaques.</p

Mean fasting blood glucose and plasma cholesterol levels during 25-week follow up.

<p>The first samples (week 0) were obtained on the day of first streptozotozin injection to induce diabetes, whereas high-cholesterol diet began at week 1 and continued until the end of study.</p

[¹⁸F]FDG Accumulation in Early Coronary Atherosclerotic Lesions in Pigs

<div><p>Objective</p><p>Inflammation is an important contributor to atherosclerosis progression. A glucose analogue ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) has been used to detect atherosclerotic inflammation. However, it is not known to what extent [¹⁸F]FDG is taken up in different stages of atherosclerosis. We aimed to study the uptake of [¹⁸F]FDG to various stages of coronary plaques in a pig model.</p><p>Methods</p><p>First, diabetes was caused by streptozotocin injections (50 mg/kg for 3 days) in farm pigs (n = 10). After 6 months on high-fat diet, pigs underwent dual-gated cardiac PET/CT to measure [¹⁸F]FDG uptake in coronary arteries. Coronary segments (n = 33) were harvested for <i>ex vivo</i> measurement of radioactivity and autoradiography (ARG).</p><p>Results</p><p>Intimal thickening was observed in 16 segments and atheroma type plaques in 10 segments. Compared with the normal vessel wall, ARG showed 1.7±0.7 times higher [¹⁸F]FDG accumulation in the intimal thickening and 4.1±2.3 times higher in the atheromas (<i>P</i> = 0.004 and <i>P</i> = 0.003, respectively). <i>Ex vivo</i> mean vessel-to-blood ratio was higher in segments with atheroma than those without atherosclerosis (2.6±1.2 vs. 1.3±0.7, <i>P</i> = 0.04). <i>In vivo</i> PET imaging showed the highest target-to-background ratio (TBR) of 2.7. However, maximum TBR was not significantly different in segments without atherosclerosis (1.1±0.5) and either intimal thickening (1.2±0.4, <i>P</i> = 1.0) or atheroma (1.6±0.6, <i>P</i> = 0.4).</p><p>Conclusions</p><p>We found increased uptake of [¹⁸F]FDG in coronary atherosclerotic lesions in a pig model. However, uptake in these early stage lesions was not detectable with <i>in vivo</i> PET imaging. Further studies are needed to clarify whether visible [¹⁸F]FDG uptake in coronary arteries represents more advanced, highly inflamed plaques.</p></div

Representative example of fused axial coronary CTA and dual-gated [¹⁸F]FDG PET images showing cross-section of the proximal right coronary artery (arrow) in an animal with atheroma.

<p>[¹⁸F]FDG accumulation in the coronary arteries was measured using CTA as an anatomical reference.</p

Box plots showing [¹⁸F]FDG accumulation in the coronary arteries by autoradiography (A), <i>ex vivo</i> biodistribution analysis (B) or <i>in vivo</i> dual-gated PET/CT imaging (C).

<p>Panel A shows [¹⁸F]FDG accumulation as an average plaque-to-normal vessel wall ratio as measured by autoradiography at the sites of normal vessel wall, intimal thickening or atheroma. Panel B shows average segmental [¹⁸F]FDG accumulation normalized to blood radioactivity in the segments without atherosclerosis, intimal thickening or atheroma plaques. Panel C shows segmental <i>in vivo</i> [¹⁸F]FDG signal as the highest target-to-background ratio (TBR) in the segments without atherosclerosis, intimal thickening or atheroma plaques.</p

Characteristics of pigs with induced diabetes and atherosclerosis at the end of study.

<p>HF = diet supplemented with 1.5% cholesterol and 15% lard, HF+c = diet supplemented with 4% cholesterol, 20% lard and 1.5% sodium cholate, BP = blood pressure</p><p>Characteristics of pigs with induced diabetes and atherosclerosis at the end of study.</p

Global myocardial blood flow (MBF) at rest or stress (A) and myocardial flow reserve (MFR) (B) were comparable in diabetic (open bars) and control (black bars) animals.

<p>Wire-myograph results of distal parts of the left anterior descending artery showing different relaxation responses to bradykinin and sodium nitroprusside (SNP) of atherosclerotic and healthy animal and between small ~150 μm (C, E, G) and larger ~300 μm (D, F, H) vessel size. The contribution of vasodilator NO to bradykinin-evoked relaxation was determined by the inhibitory effect of a nitric oxide synthase (NOS) inhibitor. * <i>P</i> < 0.05 control versus diabetic at given concentration.</p

Representative [¹⁸F]FDG autoradiograph (A) and a serial tissue section stained with Movat pentachrome (B).

<p>The inserts show areas of normal vessel wall (C), intimal thickening (D) and atheroma (E) at higher magnification. Panel F shows lipid core surrounded by densely cellular tissue at high magnification.</p