804 Rapid Fire – Obesity: problem or paradox? 4356 | BEDSIDE Effects of bariatric surgery on cardiac remodeling: clinical and pathophysiologic implications F. Graziani, A.M. Leone, P. Cialdella, E. Basile, R. Della Bona, A. Iaconelli, G. Liuzzo, L.M. Biasucci, G. Mingrone, F. Crea. Catholic University of the Sacred Heart, Rome, Italy Purpose: To assess the effects of bariatric surgery (BS) on cardiac mass, vol- umes and function as compared to persistent morbid obesity. Although beneficial effects of weight loss on cardiac function have been reported, systematic studies on the effect of BS as compared to persistent morbid obesity are lacking. Methods: One-hundred morbidly obese patients (body mass index -BMI- 47.7±7 kg/m 2 ) referred for BS prospectively underwent an echocardiogram: 65 under- went BS and 35 did not. Fifty-one operated and 29 non-operated patients under- went repeat imaging after 2 years. Results: Operated patients showed a significant decrease in weight and BMI par- alleled by a significant reduction of left ventricular (LV) mass (from 222.9±52.2 to 207.7±50g) and LV end-diastolic and end-systolic volumes (LVEDV from 124.6±29.3 to 119.4±28.7 and LVESV from 55.3±16.5 to 49.4±15ml) and by a significant increase of LV ejection fraction (from 55.9±4.8 to 59.2±4.4%). In con- trast, in non-operated patients LV mass (from 226.5±71.4 to 241.4±94.7g), vol- umes [LVEDV from 52.8±5.1 to 54.2±6.6 and LVESV from 32.1±3.5 to 34.9±6ml] significantly increased and ejection fraction deteriorated (from 57.1±5.1 to 54.7±7.4%). At multivariate analysis, BS was the only significant predictor of change in LV end-systolic volume while weight change predicted change in LV mass. Conclusions: In extreme obesity the sustained weight loss achieved with BS is associated to an improvement of cardiac structure and function, while persistent severe obesity is associated to progressive deterioration. These favorable cardiac effects associated to previously described positive metabolic effects make BS an attractive therapeutic option in this setting of patients. 4357 | BEDSIDE Association of geriatric nutritional risk index and C-reactive protein with cardiovascular morbidity in end-stage renal disease patients who just began hemodialysis therapy H. Takahashi 1 , H. Ishii 2 , T. Aoyama 3 , D. Kamoi 3 , Y. Kawamura 3 , T. Sakakibara 3 , Y. Kumada 4 , T. Murohara 2 . 1 Fujita Health University School of Medicine, Department of Internal Medicine, Division of Cardiology, Toyoake, Japan; 2 Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan; 3 Nagoya Kyoritsu Hospital, Nagoya, Japan; 4 Matsunami General Hospital, Division of Cardiovascular Surgery, Kasamatsu, Japan Background: Protein-energy wasting (PEW), commonly observed in patients with end-stage renal disease (ESRD), is currently considered to be due to not only nutritional disorder but also inflammatory process. Recently, geriatric nutri- tional risk index (GNRI) has been developed as a simplified screening tool for PEW. We investigated the association of GNRI and C-reactive protein (CRP) with future cardiovascular (CV) morbidity in ESRD patients who just began hemodial- ysis (HD) therapy. Methods: A total of 1548 ESRD patients who stably started HD therapy were examined. The GNRI was calculated from medical records at starting of HD, as follows; GNRI = (14.89 × albumin) + [41.7 × (body weight/body weight at BMI of 22)]. Patients were divided into quartiles according to GNRI levels; quartile 1 (Q1): <85.2, Q2: 85.2-91.2, Q3: 91.2-97.0 and Q4: >97.0. They were also divided into quartiles of CRP; Q1: <0.7mg/l, Q2: 0.7-1.8 mg/l, Q3: 1.8-6.1 mg/l and Q4: >6.1 mg/l. Results: Elevated CRP was independently associated with severe PEW defined as Q1 of GNRI (odds ratio 1.04, 95% CI 1.02-1.06, p=0.0004). At the 10-year follow-up, event-free survival rates for CV morbidity were 37.1%, 43.3%, 54.7% and 58.9% in Q1, Q2, Q3 and Q4 of GNRI, and were 63.6%, 55.3%, 47.8% and 32.2% in Q1, Q2, Q3 and Q4 of CRP, respectively (p<0.0001 in both). In the combined setting of GNRI and CRP, the risk of CV morbidity was 8.27-fold (95% CI 3.47-19.7) higher in Q1 of GNRI with Q4 of CRP compared to Q4 of GNRI with Q1 of CRP (p<0.0001, Figure). Similar results were also obtained for mortality. Conclusion: Lower GNRI, might reflect PEW state, and elevated CRP were closely linked, and were interactively associated with increasing risk of CV mor- bidity and mortality in ESRD patients just beginning HD therapy. 4358 | BEDSIDE Adiposity and intima media thickness in adulthood. The influence of weight loss and physical activity M. Charakida 1 , T. Khan 1 , R. Hardy 2 , J. Woodside 1 , S. Masi 1 , A.K. Ghosh 3 , A. Hughes 3 , D. Kuh 2 , J.E. Deanfield 1 . 1 University College London, Institute of Child Health, Vascular Physiology Unit, London, United Kingdom; 2 Cardiovascular Epidemiology, Medical Research Council Unit for Lifelong Health and Ageing, London, United Kingdom; 3 International Centre for Circulatory Health, Imperial College London, London, United Kingdom Purpose: Increased adiposity has been associated with adverse cardiovascular (CV) phenotype. We examined whether exposure to adiposity has a cumulative effect on carotid intima media thickness (cIMT) and whether this effect can be modified by lifestyle modifications including weight loss and physical activity. Methods: The study sample consisted of 1147 participants from the MRC Na- tional Survey of Health and Development (1946 British birth cohort) who under- went comprehensive vascular assessment between 60-64 years of age (mean age 63years). Adiposity was characterized by body mass index (BMI) at 36, 43, 53 and 63 years. Participants with BMI between 25-29 kg/m 2 were classified as overweight and those with BMI>30 kg/m 2 as obese at each age. Physical activity was assessed at the same ages using self-reported activity questionnaires. cIMT was measured in right and left carotid artery and mean cIMT was calculated. Values are expressed as mean (SD) in results. Results: Obesity prevalence increased from 26% to 66% during the 27 years of follow up. Higher BMI at every age was associated with higher cIMT (p<0.001 for all). Overweight and obese individuals (group 1, N= 762) had increased total cholesterol, HbA1c and C-reactive protein compared to those of normal weight (group 2, N=381) (p<0.001 for all). At 63 years, group 1 had higher cIMT com- pared to group 2 (0.702 (0.13) vs 0.667 (0.11) mm; p<0.001). There was a graded cumulative effect of exposure to adiposity on cIMT at 63 years, with those who were overweight or obese for >20 years having higher cIMT (N=218, cIMT: 0.72 (0.14)mm) than those with 10-20 year exposure (N=166, cIMT: 0.70 (0.12) mm) and those who were normal weight throughout (N=256, cIMT: 0.67 (0.11)mm), ANOVA: p<0.001) even after adjustment for CV risk factors and recent adiposity. Subjects in group 1 were less active compared to group 2 at all ages (p<0.001), but physical activity did not modify their vascular risk. Weight reduction (a drop in category from obese to overweight or to normal) in any time period resulted in significant vascular benefit (cIMT: 0.68 (0.11)mm) for those who lost weight (N=150) compared to those who never lost weight (cIMT: 0.70 (0.13)mm, N=190; p=0.016 adjusted for CV risk factors) even if weight loss was not sustained. Conclusion: Adiposity has a cumulative adverse effect on cIMT in adulthood. The vascular risk related to adiposity is not attenuated by physical activity unless this is associated with weight reduction. These data suggest that interventions addressing weight loss, even if not sustained, are likely to result in long term vascular benefit. 4359 | BEDSIDE Obesity paradox in asian patients with coronary artery disease after percutaneous coronary intervention H. Kaneko, J. Yajima, Y. Oikawa, S. Tanaka, D. Fukamachi, S. Suzuki, S. Matsuno, H. Kano, T. Aizawa, T. Yamashita. The Cardiovascular Institute, Tokyo, Japan Purpose: Although, obesity is strongly associated with increased risk of cardio- vascular diseases, numerous studies conducted in Western countries suggest an "obesity paradox" after percutaneous coronary intervention (PCI), whereby obese patients have better clinical outcomes compared with normal-weight patients af- ter PCI. However, it remains unclear whether obesity paradox can be applied for Asian patients. Methods: Within a single hospital-based cohort in the Shinken Database 2004– 2010, which was comprised of all new patients (n=15227) visiting the Cardiovas- cular Institute, we followed patients who underwent PCI. Major adverse cardiac Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/4358/2862457 by guest on 11 June 2020