P418 CARDIOMETABOLIC ALTERATIONS IN OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Background

Obesity and Obstructive Sleep Apnea Syndrome (OSAS) has been recognized as two of the major cardiac risk factors and they often coexist in one patient. OSAS increase the risk of as myocardial infarction, heart failure and arrhythmias. On the other hand, obesity is and independent predictor of cardiovascular mortality since it causes insulin resistance, dyslipidemia, sympathetic hyperactivation, chronic inflammation and endothelial dysfunction.

Aim

To evaluate cardiometabolic profile, echocardiographic alterations and the presence of arrhythmias in obese patients with Obstructive Sleep Apnea Syndrome and non obese patients.

Patients and Methods

67 obese patients (37 male/30 female) and 52 non obese patients (40 male/12 female) were enrolled. All subjects underwent anthropometrical evaluation and a venous blood sample for biochemical and hormonal determinations including fasting plasma glucose, fasting plasma insulin, Hba1c and OGTT to 5 hours. The insulin resistance was evaluated by HOMA–IR. All the patients underwent echocardiographic examination, polysomnographic evaluation, in order to diagnose the OSAS, and a simultaneous 12–lead Holter ECG to evaluate the presence of nocturnal arrhythmias.

Results

As expected, we found a better antropometrics profile in non obese patients. Obese patients display a severe OSAS compared to non–obese patient as shown by higher values of AHI (26.37 ±24.95 vs 16.58 ±14.07; P < 0.05), TC90 (19.61 ±24.45 vs 8.63 ±17.80; P < 0.05) and ODI (40.55 ±27.41 vs 21.06 ±22.78; P < 0,05). In obese patients we also found a significant reduction of both ejection fraction (55.54 ±7.97 vs 66.52 ±8.95; P < 0.05) and A–wave (0.75 ±0.17 vs 0.83 ±0.19; P < 0.05). In 20% of obese patients, 12–lead Holter ECG showed the presence of cardiac pause > 3 sec during apnea. In obese population alone we demonstrated a significant negative correlation between AHI and E–wave (r= –0.3; P = 0.04) and a positive correlation with interventricular septum (r = 0.38; P = 0.01) and left ventricular mass (r = 0.32; P = 0.02). Post–hoc analysis shown how these findings maintained statistical significance even when the obese patients were stratified in subgroups according to the severity of OSAS.

Conclusions

Our data, even if preliminary, seem to indicate that OSAS is not only linked to obesity but it also acts as a negative factor on the cardiometabolic risk.

P386 OBESITY AND CARDIOMYOPATHY

Background

Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy.

Aim

To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy.

Methods

383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI<30kg/m2) and obese subjects (BMI>30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI >30<35, 2= BMI >35<40, 3= BMI >40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI).

Results

Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension.

Conclusions

Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.

C72 THE EFFECTS OF BATRIATIC SURGERY ON CARDIO–METABOLIC PROFILE AND CARDIAC REMODELING

Background

Obesity is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure.

Objective

To evaluate the impact of bariatric surgery, and therefore of anthropometric and cardio–metabolic variations, on cardiac structure and function.

Methods

Twenty–six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The IR has been assessed by HOMA–IR. The patients were divided into two groups: the first group (8 patients) carried out a follow–up at 6 months post–surgery; the second group (18 patients) at 12 months post–surgery.

Results

As expected, an improvement in the anthropometric and metabolic profile in patients treated with bariatric surgery was observed. Echocardiographic data showed a significant increase in the Ejection Fraction (P < 0.001) and the E/A Ratio (P < 0.001) 6 months after bariatric surgery, a significant reduction in the Interventricular Septum thickness at 6 months (P < 0.001) and at 12 months (P < 0.002) post–surgery and a significant reduction in the Left Ventricular Mass at 6 months (P = 0.02) and at 12 months (P = 0.05) after bariatric surgery. A reduction no significant in the Left Ventricular posterior wall thickness has been observed.

Conclusions

Our data showed an increase of the systolic function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.

C77 EFFECT OF SACUBITRIL/VALSARTAN ON BOTH METABOLIC PARAMETER AND INSULIN RESISTANCE IN NON OBESE NON DIABETIC PATIENTS WITH HEART FAILURE

Background

Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). Moreover Sacubitril/Valsartan showed a significantly reduction in the HbA1c in diabetic patients. The effect of Sacubitril/Valsartan on metabolic parameter and insulin resistence in both, non obese and non diabetic patients, have not been previously described.

Aim

We evaluated the effects of the Sacubitril/Valsartan on both glycaemic and metabolic parameter, on HOMA–IR and on echocardiographic parameters in patients with HFrEF.

Methods

A total of 59 non obese and non diabetic patients with a diagnosis of HFrEF (EF < 35%) have been enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations (including fasting glucose, fasting insulin, HbA1c) and echocardiogram evaluation. Data analysis was made after 24 weeks of treatment. The insulin resistance has been assessed by HOMA–IR.

Results

Data analysis demostrated a significant reduction in fasting plasma glucose (111.4 + 11.5 vs 106 + 10 mg/dl, P = 0.03), fasting plasma insulin (13.6 + 5.9 vs 10.5 + 4.4 µUI/ml), HbA1c value (6.14 + 0.5% vs 5.9 + 0.3%, P < 0.01) and insulin resistance (HOMA–IR, 3.74 + 2.2 vs 2.7 + 2.1, P = 0.03). The echocardiogram evaluation showed a significant reduction of the end–diastolic left ventricular volume (168 + 44 vs 150 + 38 ml, P < 0.05), a no significant reduction of the end–systolic left ventricular volume (98 + 26 vs 88 + 22 ml, P = 0.07), a significant reduction of E/e1 ratio and an average 7.8% increase in ejection fraction (EF), from a mean baseline of 32.3 + 2.4 to 40.1 + 3.8% (P < 0.0001). No differences in interventricular septal (IVS) thickness, posterior wall (PW) thickness, A–wave, E–wave and E/A ratio have been observed. No differences in anthropometrical parameters (weight, body mass index, waist circumference) and blood pressure were observed.

Conclusions

Our data, even if preliminary, seem to indicate that sacubitril/valsartan might enhance glycaemic control and improve insulin resistance in non obese/non diabetic patients with HFrEF. Also, our data confirm that sacubitril/valsartan treatment is able to improve ejection fraction in HFrEF patients.

Public health implications of a case of haemolytic-uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community

The concomitant occurrence of a case of haemolytic-uraemic syndrome (HUS) and 62 cases of mild gastroenteritis in schools of a small rural community in southern Italy induced the health authorities to suspect a foodborne outbreak of shiga-toxin-producing Escherichia coli (STEC) infection. The schools were closed and the catering service involved was investigated. However, STEC were not isolated from the HUS case or from the 56 cases of gastroenteritis examined, and the HUS case and the outbreak of gastroenteritis were probably just coincidental. A retrospective cohort study failed to show any correlation with consumption of school meals and suggested that the outbreak probably started outside the school setting and then spread within the schools by person-to-person transmission. All the cases examined were negative for common enteric pathogens and the responsible agent for the cases of gastroenteritis was not identified. The concern raised in the small community by the occurrence of a severe case of HUS and the lack of a rapid epidemiological assessment excluding the occurrence of a STEC outbreak, turned an epidemic episode of mild gastroenteritis into a public health emergency with relevant socioeconomic consequences. Prompt intervention in outbreaks following timely and effective risk communication are crucial for taking the most appropriate control measures and avoiding the spread of fear and panic in the community.

Organochlorine pesticides and PCBs in wild boars from Calabria (Italy)

At present, there are no specific studies on the evaluation of environmental toxicological risks in Calabria (south of Italy) and on the presence of contaminants in the fauna of this region. The aim of the present research was to investigate the levels of contamination by OC pesticides and PCBs in some organs and tissues of wild boars (utilized as 'biological indicator') from various areas of Calabria. Quantitative determinations of organochlorines were carried out using GC-ECD and confirmed with GC-MS in 154 samples from wild boars (heart, liver, lung, kidney, muscle tissue and spleen) during the hunting season from 2000 to 2002. The results indicate the low residual levels of DDE in 8 samples and DDT in 4 samples and PCBs residues (Aroclor 1232) below the detection limits were found. Therefore, these results show that the Calabria region is not at contamination risk from organochlorines and moreover is free from health problems for the consumer of boar meat.

Levels of "toxic" and "essential" metals in samples of bovine milk from various dairy farms in Calabria, Italy

The aim of this research was to evaluate the possible contamination by heavy metals of milk from cows bred on various farms in Calabria. The concentrations of heavy metals were determined in 40 samples of bovine milk from the various dairy farms. Each sample, homogenized and powdered, was mineralized in a microwave oven. Quantitative analyses of Cd, Cr, Cu, Pb and Se were performed using an atomic absorption spectrophotometer with graphite furnace; As was analyzed by hot vapor generation technique and Zn with the flame method. As regards toxic heavy metals, highest values are those of As (g.m. 37.90 microg/kg w.w.) and Pb (g.m. 1.32 microg/kg w.w.), while lowest concentrations are those of Cd (g.m. 0.02 microg/kg w.w). With regard to essential metals, Zn (g.m. 2016 microg/kg w.w) and Se (g.m. 13.24 microg/kg w.w.) showed the highest concentrations, followed by Cr (g.m. 2.03 microg/kg w.w.) and Cu (g.m. 1.98 microg/kg w.w.). Further investigations of the levels of heavy metals (As) in a greater number of milk samples from various zones of Calabria are necessary, both to examine this problem from the clinical epidemiological point of view and to identify the possible causes of milk contamination.

Effectiveness and kinetic behaviour of tilmicosin in the treatment of respiratory infections in sheep

Nineteen sheep which were anorexic, pyrexic, coughing, dyspnoeic and had a nasal discharge and symptomatic thoracic sounds on auscultation, received a single subcutaneous dose of 10 mg/kg bodyweight of tilmicosin. The clinical signs were eliminated within four to six days. The kinetic profiles of the drug after a single subcutaneous injection were compared in five healthy sheep and five infected sheep. More of the drug was absorbed by the infected animals and its concentration remained higher for significantly longer. The drug was well tolerated and no local or systemic side effects were observed.