Borka Pezo Nikolić

Decrease in insulin resistance has a key role in improvement of metabolic profile during intragastric balloon treatment

To the Editor, Obesity is a chronic polygenic disease in most cases [1]. Despite the different pathogenesis, all obese individuals have something in common: low growth hormone (GH) levels and increased insulin levels [2]. This hormonal imbalance plays an important role in other metabolic disorders, such as glucose intolerance and dyslipidemia. Adipose tissue mass is also important factor. It is an endocrine organ that secrets several metabolic hormones and proinflammatory cytokines. The intensity of their secretion positively correlates with adipose tissue mass [3]. Weight loss improves metabolic profile, although the exact mechanism is poorly understood. A detailed study regarding this matter was published only 1 year ago. The authors disclosed that diet-induced weight loss increases GH and ghrelin levels and decreases insulin and leptin levels [2]. However, neither one study analyzed parallel changes in metabolic hormones and metabolic profile in short time intervals during weight loss. Hence, the exact causative relations between these hormones are unknown. BioEnterics intragastric balloon (BIB) is a endoscopic method in obesity treatment. The balloon placed in the stomach delays stomach emptying and enhances the feeling of satiety [4]. We aimed to investigate changes in serum insulin, C-peptide, GH, blood glucose, glycated hemoglobin, insulin resistance and lipid profile in first, third and sixth month after BIB placement. Since our previous study showed that the change in ghrelin and leptin levels during BIB treatment considerably depends on body mass index (BMI) [5], we analyzed those changes separately in obese (BMI \40 kg/m) and morbid obese (BMI \40 kg/m) patients.

Manual Intracardiac Electrogram Method Is Accurate Alternative to Echocardiography for Atrioventricular and Interventricular Optimization in Cardiac Resynchronization Therapy

Some manufacturers do not provide automated intracardiac electrogram method (IEGM) systems for atrioventricular (AV) and interventricular (VV) delay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the accuracy of manual IEGM method in 48 patients previously implanted with Medtronic Syncra CRT. All patients underwent standard device interrogation followed by CRT optimization by IEGM method and by echocardiography one month after implantation. The patient mean age was 60.7±11.8 years and there were 33 (68.8%) males. After CRT implantation, the left ventricular ejection fraction increased from 28.0±7.9% to 39.1±11.0% (p<0.001). Optimal aortic flow Velocity Time Integral (aVTI) was obtained when VV was set to 20-50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (R=0.823, p<0.001). We found no significant difference in AV, VV and aVTI values between echocardiography and IEGM method. However, IEGM was significantly less time-consuming than echocardiography [20 (10-28) vs. 40 (35-60) minutes, p<0.001]. Manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems in as many CRT devices as possible.