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Abstracts: Plenary Session 2006 / 2 (2006) 286 –309

Results: At preoperative biopsy, 27% of SOP disclosed severe steatosis (⬎⫽60 %). In multivariate analysis, ALT (p⫽0.02) and IR index (p⫽0.03) were independent predictive factors of severe steatosis at baseline. One year after surgery, surgical treatment induced a decrease in BMI (9.5 kg/m2, p⬍0.0001), steatosis score (7%, p⬍0.0001) and IR index (0.64, p⬍0.0001). In multivariate analysis, the IR index (p⫽0.03) was an independent predictive factor in persistence of severe steatosis one year after surgery and there was a trend toward significance for preoperative steatosis (p⫽0.07). Moderate or severe steatosis was more frequently observed in SOP who had conserved a higher IR index after surgery than in SOP who had improved their IR index: 47 % vs 21 %, p⫽0.02. Conclusion: Insulin resistance was independently associated with severe steatosis and was a predictor of its persistence after surgery. The amelioration of insulin resistance after surgery is connected with the decrease in fat amount. Taken together, our results support the key role of insulin resistance in the pathogenesis of severe steatosis and its amelioration as well. PII: S1550-7289(06)00294-2

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BARIX: THE NEW ADIPOSITY INDICATOR TO AID BARIATRIC SURGERY. Stephen D. Wohlgemuth, MD, FACS1, David B. Stefan, MSEE2, 1 Sentara Bariatric, Norfolk, VA, 2Novaptus Systems, Inc, Chesapeake, VA Background: BMI offers little correlation between the pre-operative bariatric surgical candidate and the degree of surgical difficulty. Pre-operative subjects may have dramatically different physical characteristics, yet have an identical BMI. Research has discovered a new adiposity indicator which utilizes torso height, torso volume and torso surface area to produce a value, called the Barix. The Barix classifies the degree of adiposity of pre-operative surgical candidates, independent of subject weight. Examination has shown a relationship between a pre-operative subject’s Barix value and the length and difficulty of the pending bariatric surgery. Methods: Pre-operative bariatric subjects of various body shapes were scanned using a white light whole body scanner. Torso height, volume and surface area information were extracted from the scan image. Each subject’s Barix was calculated. Pre-operative weight, height and BMI were recorded. Pictures of each subject’s liver were taken during the operation and the length of time and difficulty of each operation were documented. Results: BMI and Barix calculations were tabulated and compared to the length of each operation, liver size and body shape of the subject. The Barix value compared remarkably well to the size of the subject’s liver and the length and difficulty of each operation. There was no correlation between the subject’s BMI to the liver size or length and difficulty of each procedure. Conclusion: The Barix adiposity indicator appears to yield effective insight into the degree of difficulty of a pending bariatric surgical procedure, regardless of the subject’s weight, physical appearance or BMI. PII: S1550-7289(06)00295-4

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IMPROVED METABOLIC PARAMETERS, BUT NO CHANGE IN CARDIAC FUNCTION, AFTER BARIATRIC SURGERY. Joshua G. Leichman, MD1, David Aguilar, MD2, Snehal Mehta, MD3, Heinrich Taegtmeyer, MD, DPhil1, Terry K. Scarborough, MD1, Erik B. Wilson, MD1, 1 University of Texas, Houston Medical School, Houston, TX, 2 Baylor College of Medicine, Houston, TX, 3River Oaks Imaging and Diagnostics, Houston, TX. Background: Obesity is a prerequisite for the metabolic syndrome. Both conditions are characterized by a state of chronic inflammation which can lead to derangements in cardiac function. Abdominal visceral adipose tissue is an important contributor of inflammation. We hypothesize bariatric surgery reverses the dysmetabolic state and improves cardiac contractile function. Methods: Consecutively enrolled patients with severe obesity had abdominal magnetic resonance imaging to quantify visceral adipose tissue area (VATA) and tissue Doppler imaging (TDI) echocardiography to measure left ventricular (LV) contractile function. Fasting blood chemistries were drawn to measure inflammatory markers and to calculate insulin sensitivity. All tests were performed before surgery and three months post-operatively. Results: Twenty-one patients were evaluated with a mean (⫾ SEM) body mass index and age of 46 kg/m2 (1.3) and 46 years (2.4), respectively. Single slice VATA was associated with increasing concentrations of serum high sensitivity C-reactive protein (hs-CRP) (r⫽0.60, p⬍0.005) and decreasing insulin sensitivity (r⫽⫺0.47, p⫽0.03). Left ventricular systolic function, as measured by TDI, negatively correlated with VATA (r⫽⫺0.48, p⫽0.02). hs-CRP was independently associated with VATA by multivariate linear regression analysis (␤⫽0.5, p⬍0.05). Decreases in VATA with favorable changes in metabolic parameters were not associated with changes in LV contractile function three months after bariatric surgery. Conclusion: The data suggest that LV contractile function is influenced by visceral adipose tissue. The process is likely mediated by chronic inflammation. Changes observed with weight loss at three months are not accompanied by any improvement in LV contractile dysfunction. A longer period of observation may be needed. PII: S1550-7289(06)00296-6

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THE IMPACT OF BARIATRIC SURGERY ON CARDIOVASCULAR MORBIDITY/THE IMPACT OF BARIATRIC SURGERY ON MUSCULOSKELETAL MORBIDITY. Nicolas V. Christou, MD, PhD, John S. Sampalis, PhD, McGill University, Montreal, Quebec, Canada Background: We previously reported to this association that morbidly obese patients following RY gastric bypass (RYGBP) made less hospital and physician visits for cardiovascular related morbidity over a 5-year follow-up period compared to non-operated morbidly obese controls.