Impact of surgical and non-surgical weight loss on echocardiographic and strain parameters in Asian patients

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However non-surgical versus SWL and the subsequent impact on myocardial function in overweight Asian subjects has not been evaluated. Methods: 66 patients underwent a 16-week lifestyle intervention (LSI) programme consisting of dietary interventions and exercise prescription. Echocardiography with speckle tracking was performed at baseline and post-intervention. This group was compared against a group of 12 subjects who had undergone bariatric surgery and a control group of 10 lean Asian subjects. A generalised structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on strain parameters, adjusting for BMI. Results: Participants attained significant weight loss after LSI (28.2±2.66 kg/m 2 vs 25.8±2.84 kg/m 2 , p=0.001). This was associated with a non-significant trend towards improvement in strain parameters. SWL participants had significant improvement in the left ventricular global longitudinal strain (-20.52±3.34 vs -16.68±4.15, p<0.01) and left atrium reservoir strain (44.32±14.23 vs 34.3±19.31, p=0.02). Lean subjects had significantly higher strain parameters than overweight subjects. The gSEM model demonstrated surgical modality of weight loss as an independent predictor of improvement in strain parameters. Conclusion: Significant improvement in echocardiographic parameters were documented in patients who underwent bariatric surgery. Health sciences/Cardiology Health sciences/Cardiology/Cardiovascular biology/Cardiac hypertrophy Obesity Subclinical cardiac dysfunction Echocardiography Speckle-tracking strain parameters Introduction Obesity is a major public health hazard and is associated with multiple cardiovascular morbidities.(1,2) Subjects with obesity have dilatation of cardiac chambers, impairment of diastolic filling and subclinical left ventricular systolic dysfunction.(3) For example, although left ventricular ejection fraction (LVEF) appears to remain normal, the echocardiographic strain parameters of the left ventricle can be significantly reduced consistent with subclinical LV dysfunction.(4–6) In obesity, numerous studies have shown that weight loss after bariatric surgery can lead to improvement in cardiac function and long-term cardiovascular health.(6–8) Many of these studies on bariatric surgery involve morbidly obese Western populations with average body mass index (BMI) of around 50 kg/m 2 .(6,9) On the other hand, Asians with obesity tend to not have body mass indices that are as markedly elevated.(10) In fact, obesity is defined by a lower cut-off value in Asian populations.(11) In addition, rather than truncal obesity and absolute increase in the body mass, in Asians, visceral adiposity accumulates and contributes to adverse cardiovascular outcomes.(12,13) To our best knowledge, it is unknown if similar improvement in cardiac function can be demonstrated in Asian patients with obesity (who tend to have lower BMI than their Western counterparts), and also in the context of non-surgical weight loss, where the changes in weight is more modest. Therefore, we aimed to report changes in echocardiographic parameters and speckle-tracking strain parameters in Asian patients with obesity, who underwent either surgical or non-surgical weight loss. A secondary aim of our study was to assess if the modality of weight loss (either surgical or non-surgical) had a direct impact on speckle-tracking strain parameters independent of the change in BMI. Methodology Study Population We prospectively recruited individuals with elevated BMI into a non-surgical weight loss (NSWL) arm and a surgical weight loss (SWL) arm. There was also a control group of lean Asian subjects. Sixty-six (66) participants were recruited in the NSWL arm. Inclusion criteria were a BMI of 25-32 kg/m 2 and having no known prior cardiovascular disease. We excluded patients with significant changes in their diet or attempts to lose weight for the past 6 months, previous abdominal surgery, or prior psychiatric condition. A cohort of 12 participants who had undergone elective bariatric surgery were recruited into the SWL arm. Inclusion criteria for the SWL arm included a BMI of more than 35 kg/m 2 and scheduled for the bariatric surgery. Exclusion criteria were patients with known cardiovascular disease or prior psychiatric conditions. Subsequently, we compared the NSWL arm with a group of healthy lean subjects, with no prior cardiovascular history, and BMI of between 18 – 23 kg/m 2 . Informed consent was obtained from all participants. Ethical approval was granted by the Institutional Review Board of the National University Hospital, Singapore. All recruitment methods were carried out in accordance to relevant guidelines and regulations. Study Design Participants in the NSWL arm underwent a 16-week lifestyle intervention. The lifestyle intervention consisted of 5 consultations with the dietician, with the duration between visit 2 to 4 weeks apart. During the first visit with the dietician, participants were asked to provide a 24-hour recall of their dietary intake and a subsequent analysis was performed. Participants were taught the concepts of meal replacements and a sample mean plan was provided. During the second visit with the dietician, participants were taught on the different types of fat and how to identify fat content in food. Participants were taught on how to measure their caloric needs based on their weight and physical activity level and how to regulate their consumption to achieve weight loss. Subsequent consultations with the dietician entailed analysis of their food consumption and identifying any barriers participants have in being compliant to their weight-loss meal plans. Participants were also provided with exercise prescriptions which advised on exercise and physical activity sessions. Transthoracic echocardiogram was performed at baseline and after 16 weeks of lifestyle intervention. Patients in the SWL arm underwent either a sleeve gastrectomy or a gastric bypass operation. Transthoracic echocardiogram was performed at baseline and after 24 weeks after surgery. Clinical and Demographic Data Clinical and demographic data were obtained from the medical records of the clinical encounter within 1 month of the baseline echocardiogram. We also recorded information regarding history of hypertension, hyperlipidaemia and diabetes mellitus. BMI of participants, calculated by dividing weight in kilograms by height in meters squared, was measured both at baseline and after 16 weeks of lifestyle interventions or at 24 weeks after surgery for the NSWL and SWL cohorts respectively. Measurement of Echocardiographic Parameters All echocardiographic studies were performed using commercially available ultrasound systems, and images were retrospectively analyzed by experienced echocardiographers according to current guidelines.(14–16) From the parasternal long-axis view, left ventricle (LV) dimensions were assessed and LV mass was calculated by the formula of Devereux. LV end-diastolic and end-systolic volumes were assessed from the apical two- and four-chamber views and LV ejection fraction (LVEF) was calculated using the Simpson’s biplane method. Left atrium (LA) volumes were calculated using the method of discs at end-systole in the apical two- and four-chamber views. All volumes were indexed for body surface area (BSA), calculated by the formula of Du Bois. Diastolic function was assessed by pulsed-wave Doppler recordings of the transmitral flow to obtain peak early (E) and late (A) diastolic velocities. Tissue Doppler imaging of the mitral annulus on the apical four-chamber view was used to measure e’ at both the lateral and septal side, and e’ was averaged to calculate the E/e’ ratio. Pulmonary artery systolic pressure was calculated from the peak velocity of the tricuspid regurgitant jet using the Bernoulli equation, adding the right atrial pressure determined by the inspiratory collapse and diameter of the inferior vena cava.(14–16) Measurement of Strain Parameters The TOMTEC TM automated strain analysis software was used to measure strain parameters of the LV, left atrium and right ventricle. Left ventricular strain analysis was based on speckle tracking of apical 4-chamber, apical 3-chamber, and apical 2-chamber views.(15) Right ventricular strain analysis was derived on speckle tracking of right-ventricle focused apical view and left atrial strain analysis was based on the apical 4-chamber view.(17) The TOMTEC TM autostrain software utilizes an automated approach to strain analysis. The user identifies the relevant apical images for analysis before an endocardial broder is placed on the myocardium. The user can adjust the border placement and check tracking throughout the cardiac cycle to ensure accurate myocardial tracking is achieved. Statistical analysis The data were expressed as mean ± standard deviation, median (interquartile range, IQR) and frequencies (%), depending on their nature. Exploratory analyses were performed with independent t-test, Mann-Whitney U-test and Chi Square test. A generalized structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on left ventricle strain, right ventricle strain and left atrium strain, while adjusting for change in BMI. Analyzed with Stata MP Version 18 (Stata Corp, Texas, USA), all statistical tests were conducted at 5% level of significance. Results Of the 78 participants in the study, 66 (84.6%) participants were in the NSWL group, while the remaining 12 (15.4%) were in the SWL group. Baseline characteristics Baseline characteristics of all subjects are summarized in Table 1. Participants in both NSWL and SWL arms were similarly matched in age and sex distribution (age: 38.39±8.86 vs 39.83±10.32 years, p=0.312; female sex: 89.4% vs 83.3%, p=0.545). Participants in the SWL arm had significantly higher BMI than in the NSWL arm (BMI: 44.3±4.96 kg/m 2 vs 28.2±2.66 kg/m 2 , p<0.01). Participants in the SWL arm had a higher prevalence of cardiovascular co-morbidities, such as hypertension (50% vs 0%, p<0.01), hyperlipidemia (58.3% vs 4.56%, p< 0.01), and diabetes mellitus (41.67% vs 1.52%, p< 0.01). Baseline anthropometric and echocardiographic features The baseline echocardiographic features and speckle-tracking strain parameters of the NSWL and SWL cohort are listed in Table 2. As compared to the NSWL cohort, the SWL group had significantly larger left ventricular diameter in diastole (LVIDD), larger left atrium (LA), higher left ventricular mass index (LVMI) and higher relative wall thickness (RWT). Participants in the SWL cohort also had a significantly lower left ventricular ejection fraction (LVEF). In terms of tissue Doppler indices and speckle-tracking strain parameters, participants in the SWL cohort had a lower left ventricle septal E’/A’ ratio (0.993 ± 0.463 vs 1.20 ± 0.353, p=0.04) , higher left ventricle E/E’ ratio (10.14 ± 1.87 vs 8.42 ± 1.79, p<0.01), lower lateral left ventricle E’ velocity (10.83 ± 3.38 vs 13.34 ± 2.84, p=0.04) , lower left ventricle lateral E’/A’ (1.25 ± 0.605 vs 1.57 ± 0.490, p=0.02) and higher left ventricle E/E’ (7.67 ± 2.26 vs 6.4 ± 1.45, p<0.01). Participants undergoing SWL had lower global left ventricular longitudinal strain (-16.68 ± 4.15 vs -22.05 ± 2.98 %, p<0.01), right ventricular free wall strain (-19.32 ± 5.35 vs -21.56 ± 3.32,p = 0.047) and left atrial reservoir strain (34.3 ± 19.31 vs 51.456 ± 11.24, p < 0.01). Changes in anthropometric and echocardiographic features Table 3 lists the follow-up anthropometric and echocardiographic parameters of the 2 cohorts. At follow-up, both groups achieved a significant decrease in BMI. Participants in the NSWL cohort had an average BMI reduction of 2.4 kg/m 2 (p<0.01) and the SWL cohort had an average reduction of 10.3 kg/m 2 (p<0.01). Participants in the SWL cohort showed significant improvement in average LV fractional shortening (36.67±5.38 vs 37.5±5.21, p = 0.024). There was also a significant increase in mitral E velocity, left ventricle septal E’ and left ventricle lateral E’. Additionally, participants in the SWL cohort demonstrated significant improvement in speckle-tracking strain parameters in all 3 chambers measured. Patients who underwent NSWL had significant reductions in mitral A velocity, left ventricle septal A velocity and a significant increase in left ventricle E velocity. Unlike patients in the SWL cohort, patients who underwent NSWL did not have any significant improvement in their strain parameters. Analyses of the extent of changes in echocardiographic and speckle-tracking strain parameters between the SWL and NSWL cohort are listed in Table 4. Participants who underwent SWL had significantly greater reduction in LVIDD and a significant improvement in fractional shortening and left ventricle ejection fraction. Participants in the SWL cohort also had significant improvement in mitral E velocity, mitral annular tissue Doppler septal and lateral E’ velocities. The SWL cohort had also significant improvement in left ventricular global longitudinal and left atrium reservoir strain. Table 5 highlights the difference in speckle-tracking strain parameters between lean subjects and mildly overweight subjects in the NSWL cohort. Lean subjects had significantly higher strain parameters in all 3 chambers measured – left ventricle (-24.4 ± 2.5 vs -22.05 ± 2.98, p=0.02), right ventricle (-28.8 ± 5.5 vs -21.6 ± 3.3, p< 0.01), and left atrium (75.24 ± 9.174 vs 51.46 ±11.2, p < 0.01) Predictors of Improvement in Strain Parameters with gSEM Using the gSEM model (table 6) there was evidence supporting surgical modality of weight loss as an independent and significant predictor of improvement in strain parameter, after adjusting for the respective baseline strain parameters and change in BMI. Patients undergoing surgical weight loss had a significantly lower average follow-up GLS LV by about 4 units when compared with non-surgical subjects (p<0.001), after adjusting for baseline GLS LV and BMI. In the surgical cohort, patients had a significantly higher average follow-up GLS RV by about 12.6 units when compared with non-surgical subjects, after adjusted for baseline GLS RV and BMI (p<0.001). However, the impact of surgical weight loss on left atrium strain parameter was statistically non-significant (p: 0.364). Discussion Our study evaluated the difference of echocardiographic parameters and speckle-tracking strain parameters between Asian patients who were overweight undergoing NSWL and obese patients undergoing SWL. We also compared the differences in strain parameters between overweight patients undergoing NSWL and healthy lean subjects. Additionally, we evaluated the independent impact of modality of weight loss on speckle-tracking strain parameters. We found that obese participants in the SWL cohort had greater chamber enlargement in the left ventricle and left atrium as well as a lower LVEF, and a greater degree of diastolic dysfunction. Patients who were obese had lower speckle-tracking strain parameters than overweight patients in the NSWL cohort. Therefore, these findings are consistent with prior studies showing that obesity is associated with chamber dilatation, diastolic dysfunction, and cardiac dysfunction.(18–20) Furthermore, the SWL cohort showed significant improvement in fractional shortening, diastolic dysfunction indices and speckle-tracking strain parameters. Patients in the NSWL group had a trend towards improvement in cardiac function. Multiple studies have analyzed the association of obesity and cardiovascular co-morbidities including the development of cardiomyopathy and diastolic dysfunction.(21–23) The mechanisms with which obesity leads to cardiac dysfunction are likely multifactorial. For example, obesity is seen in association with hypertension as well as obstructive sleep apnea, which can lead to pathological LV remodeling when it is uncontrolled.(24,25) In addition, high levels of adiposity can also directly lead to fatty infiltration of the myocardium as well as a myocardial toxic effect, where the fatty infiltration may adversely affect myocardial elasticity and contractility.(26,27) Furthermore, persons living with obesity have chronically increased sympathetic response and decreased vagal tone which can result in pathological LV remodeling.(28) Obesity may also be linked to a pro-inflammatory state and suppressed B-type Natriuretic Peptide (BNP) that results in the clinical syndrome of heart failure over time, even in the context of preserved LVEF.(29,30) The confluence of these factors results in adverse cardiac remodeling leading to cardiac dysfunction. Our results demonstrate that subclinical cardiac dysfunction was already present in patients with BMI of 28 kg/m 2 . Cardiac magnetic resonance (CMR) imaging evaluation uncomplicated obese patients support our findings of early adverse cardiac remodeling. A CMR study conducted by Liu et al demonstrated increased LV size, thickness, and impaired myocardial contractility in Asian patients with uncomplicated obesity with a similar BMI profile of 28 kg/m 2 .(31) These findings suggest adverse remodeling starts to occur at lower levels of BMI than previously thought. To counter these adverse effects of obesity, bariatric surgery has been shown to be an effective method to cause a large reduction in BMI leading to an improvement in speckle-tracking strain parameters.(32,33) These studies had shown significant improvements following bariatric surgery in Western patients with markedly elevated BMI around 50 kg/m 2 (6,9). To date, there remained a scarcity of evidence showing similar benefits in Asians who do that have such high BMI and if bariatric surgery has a direct impact on speckle-tracking strain parameters. We demonstrated that despite body mass indices that were lower than their Western counterparts,(6,9) there were still significant improvements in the echocardiographic assessment of cardiac function following bariatric surgery in Asians. Our results also indicate that bariatric surgery was a significant predictor of improvement in speckle-tracking strain parameters, independent of change in BMI. To our knowledge, this is the first study analyzing the direct impact of surgical weight loss on strain parameters independent of BMI change. Further studies are needed to elucidate pathophysiological mechanism of the direct impact bariatric surgery has on strain parameters. However, for patients who had NSWL, with lower premorbid BMI and less reductions in BMI following intervention, we could not similarly demonstrate an improvement in these echocardiographic parameters. It is worth noting that despite modest elevation of BMI, these patients already have subclinical cardiac dysfunction, as evidenced by having significantly lower speckle-tracking strain parameters than healthy lean subjects. This suggest that the onset of subclinical cardiac dysfunction occurs at a lower BMI than previously thought. Our findings further reinforce the need for patients for patients to have aggressive weight management to be within the healthy BMI range. Our study adds to the growing body of evidence leading to the renewed focus of weight loss in the management of cardiovascular disease.(34) This is reflected in the growing prominence of Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs). GLP-1 RAs have demonstrated robust and significant reductions in major adverse cardiac events in cardiovascular outcome trials.(35–37) This has prompted for the inclusion of GLP-1 RAs in the prevention of and treatment of ischemic heart disease.(38,39) It is thought that the weight loss – inducing properties of GLP-1 RAs is a key mediator in its cardiovascular benefits(38). To the best of our knowledge, this is the first study to comprehensively evaluate the effect of non-surgical weight loss on echocardiographic parameters and speckle-tracking strain parameters in the overweight Asian population. Limitations Overall, we examined a relatively small, single-center cohort of patients undergoing SWL or NSWL. The small cohort may compromise the statistical power of the study. Furthermore, we compared two heterogenous cohorts, as they had different baseline BMI and underwent two different forms of weight loss – non-surgical versus surgical. As such, although we had only demonstrated improvement in echocardiographic parameters and speckle-tracking strain parameters in the SWL group, it could be the modest changes in BMI in the NSWL group as well as the lower baseline BMI that obscured the trends. We also did not measure the difference in the magnitude of lifestyle changes and exercise, which may also contribute to changes in cardiac function.(40) Furthermore, we did not adjust for the changes in dietary habits between the two groups, as certain component of diet may contribute to changes in myocardial strain.(41) Additionally, we have not elucidated the exact mechanism of how bariatric surgery directly improves myocardial performance independent of weight loss. Nevertheless, our findings show that the likelihood that excess weight loss resulted in the improvement in cardiac parameters, and this is consistent with obesity being associated with significant cardiovascular comorbidities. Furthermore, although this study compared the changes in echocardiographic parameters between and after SWL or NSWL, it remained to be shown if this translated to improvement symptoms or in longer-term cardiovascular outcomes, which could be an important subject of future prospective studies. Conclusion In conclusion, we find that subclinical cardiac dysfunction is present in Asian patients with obesity and even in patients who are mild overweight. These suggest that the onset of subclinical cardiac dysfunction occurs at a lower level of BMI than previously thought. There was significant improvement in echocardiographic and strain parameters following SWL, with surgical modality being an independent predictor of improvement in strain parameters. Declarations Funding No funding was obtained for this study Disclosures All the authors report no relevant disclosures Availability of materials and data The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request References GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Lond Engl. 2016;388(10053):1659–724. Bastien M, Poirier P, Lemieux I, Després JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56(4):369–81. De Pergola G, Nardecchia A, Giagulli VA, Triggiani V, Guastamacchia E, Minischetti MC, et al. Obesity and heart failure. Endocr Metab Immune Disord Drug Targets. 2013;13(1):51–7. 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Tables Table 1 Baseline Clinical Characteristics Variables Non-Surgical Weight Loss N = 66 Surgical Weight Loss N = 12 P-Value Demographics and Comorbidities Age, years 38.39 ± 8.86 39.83 ± 10.32 0.312 Female sex, (%) 59 (89.4) 10 (83.3) 0.545 Hypertension, (%) 0 (0) 6 (50) < 0.01 Hyperlipidaemia, (%) 3 (4.56) 7 (58.3) < 0.01 Diabetes Mellitus, (%) 1 (1.52) 5 (41.67) < 0.01 Type of Bariatric Surgery Sleeve Gastrectomy, (%) Gastric Bypass, (%) N.A 10 (83.3) 2 (16.7) N.A Body Mass Index, kg/m 2 28.20 ± 2.66 44.3 ± 4.96 < 0.01 Reduction in Body Mass Index, kg/m 2 -2.4 ± 1.12 -10.30 ± 2.74 < 0.01 Table 2 Differences in Baseline Echocardiographic Parameters and Speckle Strain Parameters Variables Non-Surgical Weight Loss N = 66 Surgical Weight Loss N = 12 P-Value Echocardiographic Parameters Left Ventricular Internal Diameter diastole, mm 45.94 ± 3.01 50.25 ± 5.17 < 0.01 Left Ventricular Internal Diameter systole, mm 30.58 ± 5.64 32.42 ± 5.32 0.151 Left Ventricular Mass Index, g/m 2 66.74 ± 12.085 80.83 ± 22.99 < 0.01 Relative Wall Thickness 0.338 ± 0.041 0.385 +/ 0.032 < 0.01 Fractional Shortening, % 36.95 ± 3.42 35.67 ± 5.38 0.145 Left Atrium, mm 34.0 ± 4.13 39.67 ± 6.27 < 0.01 Aortic Root Diameter, mm 27.88 ± 2.48 30.92 ± 3.18 < 0.01 E-Point to Septal Separation, mm 5.02 ± 2.06 5.82 ± 3.03 0.144 Left Ventricular Ejection fraction, visual, % 65.31 ± 3.93 62.67 ± 5.33 0.02 Mitral Deceleration Time, msec 170 ± 27.44 171.92 ± 19.12 0.409 Mitral E Velocity, cm/s 82.89 ± 14.87 78.42 ± 19.00 0.183 Mitral A Velocity, cm/s 55.80 ± 10.52 67.17 ± 22.04 < 0.01 Mitral E/A 1.53 ± 0.378 1.35 ± 0.716 0.10 Left Ventricle Septal E’ Velocity, cm/s 10.28 ± 2.19 7.75 ± 1.76 0.109 Left Ventricle Septal A’ Velocity, cm/s 8.71 ± 1.27 8.92 ± 2.54 0.339 Left Ventricle Septal E’/A’ Velocity 1.20 ± 0.353 0.993 ± 0.463 0.04 Left Ventricle Septal E/E’ 8.42 ± 1.79 10.14 ± 1.87 < 0.01 Left Ventricle Lateral E, cm/s 13.34 ± 2.84 10.83 ± 3.38 0.04 Left Ventricle Lateral A’, cm/s 8.88 ± 1.71 9.58 ± 2.19 0.11 Left Ventricle Lateral E’/A’ 1.57 ± 0.490 1.25 ± 0.605 0.02 Left Ventricle Lateral E/E’ 6.40 ± 1.45 7.67 ± 2.26 < 0.01 Right Ventricle E’, cm/s 12.86 ± 2.71 11.17 ± 2.44 0.02 Right Ventricle A’, cm/s 11.79 ± 2.30 12.75 ± 4.11 0.175 Right Ventricle E’/A’ 1.15 ± 0.321 0.961 ± 0.375 0.04 Pulmonary Artery Systolic Pressure, mmHg 24.02 ± 4.015 23 ± 2.37 0.274 Speckle-Tracking Strain Parameters Left ventricular global longitudinal strain, % -22.05 ± 2.98 -16.68 ± 4.15 < 0.01 Right ventricular free wall strain, % -21.56 ± 3.32 -19.32 ± 5.35 0.047 Left atrium reservoir strain, % 51.456 ± 11.24 34.3 ± 19.31 < 0.01 Table 3 Echocardiographic and Speckle Strain Parameters at Baseline and Follow-Up Non-surgical Weight Loss, N = 66 Surgical Weight Loss, N = 12 Parameters Baseline Post-Intervention (4 months) Baseline Post-Intervention (6-months) P-value 1 P-Value 2 Body Mass Index, kg/m 2 28.20 ± 2.66 25.8 ± 2.84 44.3 ± 4.96 34.0 ± 2.22 < 0.01 < 0.01 Left Ventricular Internal Diameter diastole, mm 45.94 ± 3.01 46.20 ± 3.31 50.25 ± 5.17 49.83 ± 4.06 0.288 0.807 Left Ventricular Internal Diameter systole, mm 30.58 ± 5.64 30.72 ± 5.31 32.42 ± 5.32 30.17 ± 3.41 0.133 0.140 Left Ventricular Mass Index, g/m 2 66.74 ± 12.085 68.47 ± 12.67 80.83 ± 22.99 88.42 ± 23.16 0.123 0.151 Relative Wall Thickness 0.338 ± 0.041 0.333 ± 0.053 0.385 +/ 0.032 0.386 ± 0.072 0.423 0.959 Fractional Shortening, % 36.95 ± 3.42 36.76 ± 3.33 35.67 ± 5.38 39.42 ± 5.76 0.370 0.024 Left Atrium, mm 34.0 ± 4.13 33.85 ± 3.53 39.67 ± 6.27 39.5 ± 5.09 0.447 0.897 Aortic Root Diameter, mm 27.88 ± 2.48 27.96 ± 2.76 30.92 ± 3.18 30.42 ± 2.71 0.469 0.551 E-Point to Septal Separation, mm 5.02 ± 2.06 5.20 ± 1.73 5.82 ± 3.03 5.8 ± 2.30 0.246 0.813 Left Ventricular Ejection fraction, visual, % 65.31 ± 3.93 65.11 ± 3.53 62.67 ± 5.33 65.9 ± 4.08 0.759 0.067 Mitral Deceleration Time, ms 170 ± 27.44 171.98 ± 30.64 171.92 ± 19.12 174.08 ± 21.91 0.373 0.792 Mitral E Velocity, cm/s 82.89 ± 14.87 82.06 ± 19.14 78.42 ± 19.00 85.92 ± 17.89 0.279 0.04 Mitral A Velocity, cm/s 55.80 ± 10.52 54.0 ± 11.82 67.17 ± 22.04 63.25 ± 25.0 0.0277 0.305 Mitral E/A 1.53 ± 0.378 1.56 ± 0.422 1.35 ± 0.716 1.68 ± 1.05 0.201 0.121 Left Ventricle Septal E’ Velocity, cm/s 10.28 ± 2.19 10.43 ± 2.10 7.75 ± 1.76 10.08 ± 2.87 0.424 < 0.01 Left Ventricle Septal A’ Velocity, cm/s 8.71 ± 1.27 8.44 ± 1.49 8.92 ± 2.54 8.75 ± 1.86 0.046 0.778 Left Ventricle Septal E’/A’ Velocity 1.20 ± 0.353 1.29 ± 0.369 0.993 ± 0.463 1.25 ± 0.585 0.038 0.08 Left Ventricle Septal E/E’ 8.42 ± 1.79 8.01 ± 2.10 10.14 ± 1.87 8.83 ± 1.66 0.230 0.045 Left Ventricle Lateral E, cm/s 13.34 ± 2.84 14.20 ± 3.42 10.83 ± 3.38 12.92 ± 3.50 < 0.01 < 0.01 Left Ventricle Lateral A’, cm/s 8.88 ± 1.71 8.56 ± 1.35 9.58 ± 2.19 9.33 ± 2.87 0.073 0.748 Left Ventricle Lateral E’/A’ 1.57 ± 0.490 1.70 ± 0.488 1.25 ± 0.605 1.38 ± 0.602 < 0.01 0.07 Left Ventricle Lateral E/E’ 6.40 ± 1.45 5.93 ± 1.41 7.67 ± 2.26 7.0 ± 1.88 0.061 0.331 Right Ventricle E’, cm/s 12.86 ± 2.71 12.59 ± 2.84 11.17 ± 2.44 12.83 ± 2.25 0.129 0.107 Right Ventricle A’, cm/s 11.79 ± 2.30 11.76 ± 2.74 12.75 ± 4.11 12.45 ± 3.62 0.234 0.684 Right Ventricle E’/A’ 1.15 ± 0.321 1.12 ± 0.343 0.961 ± 0.375 1.09 ± 0.378 0.605 0.338 Pulmonary Artery Systolic Pressure, mmHg 24.02 ± 4.015 22.86 ± 4.51 23 ± 2.37 26 ± 7.46 0.140 0.406 Speckle-Tracking Strain Parameters Left ventricular global longitudinal strain, % -22.05 ± 2.98 -22.77 ± 3.21 -16.68 ± 4.15 -20.52 ± 3.34 0.125 < 0.01 Right ventricular free wall strain, % -21.56 ± 3.32 -22.02 ± 3.59 -19.32 ± 5.35 -23.49 ± 6.42 0.404 0.03 Left atrium reservoir strain, % 51.456 ± 11.24 48.78 ± 19.09 34.3 ± 19.31 44.32 ± 14.23 0.190 0.02 1: P-value comparing Non-Surgical Weight Loss at baseline and post intervention 2: P-value comparing Surgical Weight Loss at baseline and post-intervention Table 4 Differences in Extent of Changes at Follow-Up between Non-Surgical Weight Loss and Surgical Weight Loss Cohort Variables Non-Surgical Weight Loss N = 66 Surgical Weight Loss N = 12 P-Value Anthropometric Reduction in BMI, kg/m 2 -2.4 ± 1.12 -10.30 ± 2.74 < 0.01 Echocardiographic Parameters Left Ventricular Internal Diameter diastole, mm 0.184 ± 2.52 -0.417 ± 5.78 0.362 Left Ventricular Internal Diameter systole, mm 0.345 ± 2.28 -2.25 ± 4.90 < 0.01 Left Ventricular Mass Index, g/m 2 3.02 ± 14.4 7.58 ± 24.25 0.195 Relative Wall Thickness -0.00185 ± 0.0697 0.000833 ± 0.0552 0.451 Fractional Shortening, % -0.182 ± 4.04 3.75 ± 5.86 < 0.01 Left Atrium, mm -0.0566 ± 3.07 -0.167 ± 4.37 0.459 E-Point to Septal Separation, mm 0 ± 1.91 -0.222 ± 2.73 0.386 Left Ventricular Ejection fraction, visual, % -0.316 ± 4.02 3.25 ± 5.53 < 0.01 Mitral Deceleration Time, ms 1.46 ± 32.32 2.17 ± 27.71 0.472 Mitral E Velocity, cm/s -2.94 ± 11.77 7.5 ± 11.45 < 0.01 Mitral A Velocity, cm/s -2.53 ± 9.40 -3.92 ± 12.62 0.333 Mitral E/A 0.0393 ± 0.342 0.147 ± 0.250 0.163 Left Ventricle Septal E’ Velocity, cm/s 0.0547 ± 2.08 2 ± 1.90 < 0.01 Left Ventricle Septal A’ Velocity, cm/s -0.372 ± 1.60 -0.167 ± 2.0 0.351 Left Ventricle Septal E’/A’ Velocity, 0.0628 ± 0.399 0.258 ± 0.458 0.069 Left Ventricle Septal E/E’ -0.369 ± 1.73 -1.31 ± 2.0 0.0513 Left Ventricle Lateral E, cm/s 0.858 ± 2.28 2.08 ± 1.44 0.04 Left Ventricle Lateral A’, cm/s -0.325 ± 1.60 -0.364 ± 2.63 0.449 Left Ventricle Lateral E’/A’ 0.121 ± 0.376 0.162 ± 0.27 0.369 Left Ventricle Lateral E/E’ -0.615 ± 1.63 -0.671 ± 2.29 0.461 Right Ventricle E’, cm/s -0.451 ± 2.87 -1.67 ± 3.29 0.101 Right Ventricle A’, cm/s -0.311 ± 3.13 -0.364 ± 2.87 0.480 Right Ventricle E’/A’ -0.0157 ± 0.299 0.0425 ± 0.368 0.281 Speckle-Tracking Strain Parameters Left ventricular global longitudinal strain, % -1.13 ± 3.39 -3.84 ± 2.90 0.011 Right ventricular free wall strain, % -1.24 ± 6.01 -4.17 ± 5.83 0.09 Left atrium reservoir strain, % 1.35 ± 13.96 10.02 ± 13.44 0.0386 Table 5 Speckle-Tracking Strain Parameters Between Lean vs Overweight Subjects Lean Subjects (N = 10) Overweight Subjects (N = 66) P-value Age, years 33.92 +/- 7.6 38.39 +/- 8.9 0.112 Female sex, % 7 (70%) 59 (89.4) 0.09 Body Mass Index, kg/m 2 19.4 +/- 3.04 28.2 +/- 2.66 < 0.01 Left ventricular global longitudinal. strain, % -24.4 +/- 2.5 -22.05 +/- 2.98 0.02 Right ventricular free wall strain, % -28.8 +/- 5.5 -21.6 +/- 3.3 < 0.01 Left atrium reservoir strain, % 75.24 +/- 9.174 51.46 +/- 11.2 < 0.01 Table 6 Impact of Surgical Weight Loss on Strain Parameters – Structural Equation Model 1 Variable Coefficient 95% Confidence Interval P value Left Ventricle Strain -4.01 -6.46 - -1.557 0.001 Right Ventricle Strain 12.56 5.67–19.44 < 0.001 Left Atrium Strain -3.3 -10.4–3.82 0.364 1 Structural Equation Model has been adjusted for body mass index Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4194533","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":297288433,"identity":"8b5490d0-8794-4e4f-a16e-834674dae7b9","order_by":0,"name":"Kian Keong 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07:14:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4194533/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4194533/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-69586-y","type":"published","date":"2024-10-15T15:56:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67149052,"identity":"2bb95760-ecd0-45be-ac75-cda8de424ea6","added_by":"auto","created_at":"2024-10-21 16:11:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":894429,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4194533/v1/7c43e014-1690-482e-a04e-8347e242b923.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of surgical and non-surgical weight loss on echocardiographic and strain parameters in Asian patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a major public health hazard and is associated with multiple cardiovascular morbidities.(1,2) Subjects with obesity have dilatation of cardiac chambers, impairment of diastolic filling and subclinical left ventricular systolic dysfunction.(3) For example, although left ventricular ejection fraction (LVEF) appears to remain normal, the echocardiographic strain parameters of the left ventricle can be significantly reduced consistent with subclinical LV dysfunction.(4\u0026ndash;6)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn obesity, numerous studies have shown that weight loss after bariatric surgery can lead to improvement in cardiac function and long-term cardiovascular health.(6\u0026ndash;8)\u0026nbsp;Many of these studies on bariatric surgery involve morbidly obese Western populations with average body mass index (BMI) of around 50 kg/m\u003csup\u003e2\u003c/sup\u003e.(6,9)\u003c/p\u003e\n\u003cp\u003eOn the other hand, Asians with obesity tend to not have body mass indices that are as markedly elevated.(10) In fact, obesity is defined by a lower cut-off value in Asian populations.(11) In addition, rather than truncal obesity and absolute increase in the body mass, in Asians, visceral adiposity accumulates and contributes to adverse cardiovascular outcomes.(12,13)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo our best knowledge, it is unknown if similar improvement in cardiac function can be demonstrated in Asian patients with obesity (who tend to have lower BMI than their Western counterparts), and also in the context of non-surgical weight loss, where the changes in weight is more modest. Therefore, we aimed to report changes in echocardiographic parameters and speckle-tracking strain parameters in Asian patients with obesity, who underwent either surgical or non-surgical weight loss. A secondary aim of our study was to assess if the modality of weight loss (either surgical or non-surgical) had a direct impact on speckle-tracking strain parameters independent of the change in BMI.\u0026nbsp;\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cu\u003eStudy Population\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWe prospectively recruited individuals with elevated BMI into\u0026nbsp;a non-surgical weight loss (NSWL) arm and a surgical weight loss (SWL) arm. \u0026nbsp;There was also a control group of lean Asian subjects. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSixty-six (66) participants were recruited in the NSWL arm. Inclusion criteria were a BMI of 25-32 kg/m\u003csup\u003e2\u003c/sup\u003e and having no known prior cardiovascular disease. We excluded patients with significant changes in their diet or attempts to lose weight for the past 6 months, previous abdominal surgery, or prior psychiatric condition. A cohort of 12 participants who had undergone elective bariatric surgery were recruited into the SWL arm. Inclusion criteria for the SWL arm included a BMI of more than 35 kg/m\u003csup\u003e2\u003c/sup\u003e and scheduled for the bariatric surgery. Exclusion criteria were patients with known cardiovascular disease or prior psychiatric conditions. Subsequently, we compared the NSWL arm with a group of healthy lean subjects, with no prior cardiovascular history, and BMI of between 18 \u0026ndash; 23 kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants. Ethical approval was granted by the Institutional Review Board of the National University Hospital, Singapore. All recruitment methods were carried out in accordance to relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStudy Design\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the NSWL arm underwent a 16-week lifestyle intervention. The lifestyle intervention consisted of 5 consultations with the dietician, with the duration between visit 2 to 4 weeks apart. During the first visit with the dietician, participants were asked to provide a 24-hour recall of their dietary intake and a subsequent analysis was performed. Participants were taught the concepts of meal replacements and a sample mean plan was provided. During the second visit with the dietician, participants were taught on the different types of fat and how to identify fat content in food. Participants were taught on how to measure their caloric needs based on their weight and physical activity level and how to regulate their consumption to achieve weight loss. \u0026nbsp;Subsequent consultations with the dietician entailed analysis of their food consumption and identifying any barriers participants have in being compliant to their weight-loss meal plans. Participants were also provided with exercise prescriptions which advised on exercise and physical activity sessions. Transthoracic echocardiogram was performed at baseline and after 16 weeks of lifestyle intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients in the SWL arm underwent either a sleeve gastrectomy or a gastric bypass operation. Transthoracic echocardiogram was performed at baseline and after 24 weeks after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eClinical and Demographic Data\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eClinical and demographic data were obtained from the medical records of the clinical encounter within 1 month of the baseline echocardiogram. We also recorded information regarding history of hypertension, hyperlipidaemia and diabetes mellitus. BMI of participants, calculated by dividing weight in kilograms by height in meters squared, was measured both at baseline and after 16 weeks of lifestyle interventions or at 24 weeks after surgery for the NSWL and SWL cohorts respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMeasurement of Echocardiographic Parameters\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll echocardiographic studies were performed using commercially available ultrasound systems, and images were retrospectively analyzed by experienced echocardiographers according to current guidelines.(14\u0026ndash;16) From the parasternal long-axis view, left ventricle (LV) dimensions were assessed and LV mass was calculated by the formula of Devereux. LV end-diastolic and end-systolic volumes were assessed from the apical two- and four-chamber views and LV ejection fraction (LVEF) was calculated using the Simpson\u0026rsquo;s biplane method. Left atrium (LA) volumes were calculated using the method of discs at end-systole in the apical two- and four-chamber views. All volumes were indexed for body surface area (BSA), calculated by the formula of Du Bois. Diastolic function was assessed by pulsed-wave Doppler recordings of the transmitral flow to obtain peak early (E) and late (A) diastolic velocities. Tissue Doppler imaging of the mitral annulus on the apical four-chamber view was used to measure e\u0026rsquo; at both the lateral and septal side, and e\u0026rsquo; was averaged to calculate the E/e\u0026rsquo; ratio. Pulmonary artery systolic pressure was calculated from the peak velocity of the tricuspid regurgitant jet using the Bernoulli equation, adding the right atrial pressure determined by the inspiratory collapse and diameter of the inferior vena cava.(14\u0026ndash;16)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMeasurement of Strain Parameters\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe TOMTEC\u003csup\u003eTM\u003c/sup\u003e automated strain analysis software was used to measure strain parameters of the LV, left atrium and right ventricle. Left ventricular strain analysis was based on speckle tracking of apical 4-chamber, apical 3-chamber, and apical 2-chamber views.(15) Right ventricular strain analysis was derived on speckle tracking of right-ventricle focused apical view and left atrial strain analysis was based on the apical 4-chamber view.(17) The TOMTEC\u003csup\u003eTM\u003c/sup\u003e autostrain software utilizes an automated approach to strain analysis. The user identifies the relevant apical images for analysis before an endocardial broder is placed on the myocardium. The user can adjust the border placement and check tracking throughout the cardiac cycle to ensure accurate myocardial tracking is achieved.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStatistical analysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe data were expressed as mean \u0026plusmn; standard deviation, median (interquartile range, IQR) and frequencies (%), depending on their nature. Exploratory analyses were performed with independent t-test, Mann-Whitney U-test and Chi Square test. A generalized structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on left ventricle strain, right ventricle strain and left atrium strain, while adjusting for change in BMI. Analyzed with Stata MP Version 18 (Stata Corp, Texas, USA), all statistical tests were conducted at 5% level of significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 78 participants in the study, 66 (84.6%) participants were in the NSWL group, while the remaining 12 (15.4%) were in the SWL group. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eBaseline characteristics\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eBaseline characteristics of all subjects are summarized in Table 1. Participants in both NSWL and SWL arms were similarly matched in age and sex distribution (age: 38.39\u0026plusmn;8.86 vs 39.83\u0026plusmn;10.32 years, p=0.312; female sex: 89.4% vs 83.3%, p=0.545). Participants in the SWL arm had significantly higher BMI than in the NSWL arm (BMI: 44.3\u0026plusmn;4.96 kg/m\u003csup\u003e2\u003c/sup\u003e vs 28.2\u0026plusmn;2.66 kg/m\u003csup\u003e2\u003c/sup\u003e, p\u0026lt;0.01). Participants in the SWL arm had a higher prevalence of cardiovascular co-morbidities, such as hypertension (50% vs 0%, p\u0026lt;0.01), hyperlipidemia (58.3% vs 4.56%, p\u0026lt; 0.01), and diabetes mellitus (41.67% vs 1.52%, p\u0026lt; 0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eBaseline anthropometric and echocardiographic features\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe baseline echocardiographic features and speckle-tracking strain parameters of the NSWL and SWL cohort are listed in Table 2. As compared to the NSWL cohort, the SWL group had significantly larger left ventricular diameter in diastole (LVIDD), larger left atrium (LA), higher left ventricular mass index (LVMI) and higher relative wall thickness (RWT). Participants in the SWL cohort also had a significantly lower left ventricular ejection fraction (LVEF).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of tissue Doppler indices and speckle-tracking strain parameters, participants in the SWL cohort had a lower left ventricle septal E\u0026rsquo;/A\u0026rsquo; ratio (0.993 \u0026plusmn; 0.463 vs 1.20 \u0026plusmn; 0.353, p=0.04) \u0026nbsp;, higher left ventricle E/E\u0026rsquo; ratio (10.14 \u0026plusmn; 1.87 vs 8.42 \u0026plusmn; 1.79, p\u0026lt;0.01), lower lateral left ventricle E\u0026rsquo; velocity (10.83 \u0026plusmn; 3.38 vs 13.34 \u0026plusmn; 2.84, p=0.04) \u0026nbsp;, lower left ventricle lateral E\u0026rsquo;/A\u0026rsquo; (1.25 \u0026plusmn; 0.605 vs 1.57 \u0026plusmn; 0.490, p=0.02) and higher left ventricle E/E\u0026rsquo; (7.67 \u0026plusmn; 2.26 vs 6.4 \u0026plusmn; 1.45, p\u0026lt;0.01). Participants undergoing SWL had lower global left ventricular longitudinal strain (-16.68 \u0026plusmn; 4.15 vs -22.05 \u0026plusmn; 2.98 %, p\u0026lt;0.01), right ventricular free wall strain (-19.32 \u0026plusmn; 5.35 vs -21.56 \u0026plusmn; 3.32,p = 0.047) and left atrial reservoir strain (34.3 \u0026plusmn; 19.31 vs 51.456 \u0026plusmn; 11.24, p \u0026lt; 0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eChanges in anthropometric and echocardiographic features\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 lists the follow-up anthropometric and echocardiographic parameters of the 2 cohorts. At follow-up, both groups achieved a significant decrease in BMI. Participants in the NSWL cohort had an average BMI reduction of 2.4 kg/m\u003csup\u003e2\u003c/sup\u003e (p\u0026lt;0.01) and the SWL cohort had an average reduction of 10.3 kg/m\u003csup\u003e2\u003c/sup\u003e (p\u0026lt;0.01). Participants in the SWL cohort showed significant improvement in average LV fractional shortening (36.67\u0026plusmn;5.38 vs 37.5\u0026plusmn;5.21, p = 0.024). There was also a significant increase in mitral E velocity, left ventricle septal E\u0026rsquo; and left ventricle lateral E\u0026rsquo;. Additionally, participants in the SWL cohort demonstrated significant improvement in speckle-tracking strain parameters in all 3 chambers measured. Patients who underwent NSWL had significant reductions in mitral A velocity, left ventricle septal A velocity and a significant increase in left ventricle E velocity. Unlike patients in the SWL cohort, patients who underwent NSWL did not have any significant improvement in their strain parameters.\u003c/p\u003e\n\u003cp\u003eAnalyses of the extent of changes in echocardiographic and speckle-tracking strain parameters between the SWL and NSWL cohort are listed in Table 4. Participants who underwent SWL had significantly greater reduction in LVIDD and a significant improvement in fractional shortening and left ventricle ejection fraction. Participants in the SWL cohort also had significant improvement in mitral E velocity, mitral annular tissue Doppler septal and lateral E\u0026rsquo; velocities. The SWL cohort had also significant improvement in left ventricular global longitudinal and left atrium reservoir strain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 highlights the difference in speckle-tracking strain parameters between lean subjects and mildly overweight subjects in the NSWL cohort. Lean subjects had significantly higher strain parameters in all 3 chambers measured \u0026ndash; left ventricle (-24.4 \u0026nbsp; \u0026plusmn; 2.5 vs -22.05 \u0026plusmn; 2.98, p=0.02), right ventricle (-28.8 \u0026plusmn; 5.5 vs -21.6 \u0026plusmn; 3.3, p\u0026lt; 0.01), and left atrium (75.24 \u0026plusmn; 9.174 vs 51.46 \u0026plusmn;11.2, p \u0026lt; 0.01)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePredictors of Improvement in Strain Parameters with gSEM\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eUsing the gSEM model (table 6) there was evidence supporting surgical modality of weight loss as an independent and significant predictor of improvement in strain parameter, after adjusting for the respective baseline strain parameters and change in BMI. Patients undergoing surgical weight loss had a significantly lower average follow-up GLS LV by about 4 units when compared with non-surgical subjects (p\u0026lt;0.001), after adjusting for baseline GLS LV and BMI. In the surgical cohort, patients had a significantly higher average follow-up GLS RV by about 12.6 units when compared with non-surgical subjects, after adjusted for baseline GLS RV and BMI (p\u0026lt;0.001). However, the impact of surgical weight loss on left atrium strain parameter was statistically non-significant (p: 0.364).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study evaluated the difference of echocardiographic parameters and speckle-tracking strain parameters between Asian patients who were overweight undergoing NSWL and obese patients undergoing SWL. We also compared the differences in strain parameters between overweight patients undergoing NSWL and healthy lean subjects. Additionally, we evaluated the independent impact of modality of weight loss on speckle-tracking strain parameters. We found that obese participants in the SWL cohort had greater chamber enlargement in the left ventricle and left atrium as well as a lower LVEF, and a greater degree of diastolic dysfunction. Patients who were obese had lower speckle-tracking strain parameters than overweight patients in the NSWL cohort. Therefore, these findings are consistent with prior studies showing that obesity is associated with chamber dilatation, diastolic dysfunction, and cardiac dysfunction.(18\u0026ndash;20) Furthermore, the SWL cohort showed significant improvement in fractional shortening, diastolic dysfunction indices and speckle-tracking strain parameters. Patients in the NSWL group had a trend towards improvement in cardiac function.\u003c/p\u003e\n\u003cp\u003eMultiple studies have analyzed the association of obesity and cardiovascular co-morbidities including the development of cardiomyopathy and diastolic dysfunction.(21\u0026ndash;23) The mechanisms with which obesity \u0026nbsp;leads to cardiac dysfunction are likely multifactorial. For example, obesity is seen in association with hypertension as well as obstructive sleep apnea, which can lead to pathological LV remodeling when it is uncontrolled.(24,25) In addition, high levels of adiposity can also directly lead to fatty infiltration of the myocardium as well as a myocardial toxic effect, where the fatty infiltration may adversely affect myocardial elasticity and contractility.(26,27) Furthermore, persons living with obesity have chronically increased sympathetic response and decreased vagal tone which can result in pathological LV remodeling.(28) Obesity may also be linked to a pro-inflammatory state and suppressed B-type Natriuretic Peptide (BNP) that results in the clinical syndrome of heart failure over time, even in the context of preserved LVEF.(29,30) The confluence of these factors results in adverse cardiac remodeling leading to cardiac dysfunction. Our results demonstrate that subclinical cardiac dysfunction was already present in patients with BMI of 28 kg/m\u003csup\u003e2\u003c/sup\u003e. Cardiac magnetic resonance (CMR) imaging evaluation uncomplicated obese patients support our findings of early adverse cardiac remodeling. A CMR study conducted by Liu et al demonstrated increased LV size, thickness, and impaired myocardial contractility in Asian patients with uncomplicated obesity with a similar BMI profile of 28 kg/m\u003csup\u003e2\u003c/sup\u003e.(31) These findings suggest adverse remodeling starts to occur at lower levels of BMI than previously thought.\u003c/p\u003e\n\u003cp\u003eTo counter these adverse effects of obesity, bariatric surgery has been shown to be an effective method to cause a large reduction in BMI leading to an improvement in speckle-tracking strain parameters.(32,33)\u0026nbsp;These studies had shown significant improvements following bariatric surgery in Western patients with markedly elevated BMI around 50 kg/m\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(6,9). To date, there remained a scarcity of evidence showing similar benefits in Asians who do that have such high BMI and if bariatric surgery has a direct impact on speckle-tracking strain parameters. We demonstrated that despite body mass indices that were lower than their Western counterparts,(6,9) there were still significant improvements in the echocardiographic assessment of cardiac function following bariatric surgery in Asians. Our results also indicate that bariatric surgery was a significant predictor of improvement in speckle-tracking strain parameters, independent of change in BMI. To our knowledge, this is the first study analyzing the direct impact of surgical weight loss on strain parameters independent of BMI change. Further studies are needed to elucidate pathophysiological mechanism of the direct impact bariatric surgery has on strain parameters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, for patients who had NSWL, with lower premorbid BMI and less reductions in BMI following intervention, we could not similarly demonstrate an improvement in these echocardiographic parameters. It is worth noting that despite modest elevation of BMI, these patients already have subclinical cardiac dysfunction, as evidenced by having significantly lower speckle-tracking strain parameters than healthy lean subjects. This suggest that the onset of subclinical cardiac dysfunction occurs at a lower BMI than previously thought. Our findings further reinforce the need for patients for patients to have aggressive weight management to be within the healthy BMI range. \u0026nbsp; Our study adds to the growing body of evidence leading to the renewed focus of weight loss in the management of cardiovascular disease.(34) This is reflected in the growing prominence of Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs). GLP-1 RAs have demonstrated robust and significant reductions in major adverse cardiac events in cardiovascular outcome trials.(35\u0026ndash;37) This has prompted for the inclusion of GLP-1 RAs in the prevention of and treatment of ischemic heart disease.(38,39) It is thought that the weight loss \u0026ndash; inducing properties of GLP-1 RAs is a key mediator in its cardiovascular benefits(38). To the best of our knowledge, this is the first study to comprehensively evaluate the effect of non-surgical weight loss on echocardiographic parameters and speckle-tracking strain parameters in the overweight Asian population. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, we examined a relatively small, single-center cohort of patients undergoing SWL or NSWL. The small cohort may compromise the statistical power of the study. Furthermore, we compared two heterogenous cohorts, as they had different baseline BMI and underwent two different forms of weight loss \u0026ndash; non-surgical versus surgical. As such, although we had only demonstrated improvement in echocardiographic parameters and speckle-tracking strain parameters in the SWL group, it could be the modest changes in BMI in the NSWL group as well as the lower baseline BMI that obscured the trends. We also did not measure the difference in the magnitude of lifestyle changes and exercise, which may also contribute to changes in cardiac function.(40) Furthermore, we did not adjust for the changes in dietary habits between the two groups, as certain component of diet may contribute to changes in myocardial strain.(41) Additionally, we have not elucidated the exact mechanism of how bariatric surgery directly improves myocardial performance independent of weight loss. Nevertheless, our findings show that the likelihood that excess weight loss resulted in the improvement in cardiac parameters, and this is consistent with obesity being associated with significant cardiovascular comorbidities. Furthermore, although this study compared the changes in echocardiographic parameters between and after SWL or NSWL, it remained to be shown if this translated to improvement symptoms or in longer-term cardiovascular outcomes, which could be an important subject of future prospective studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, we find that subclinical cardiac dysfunction is present in Asian patients with obesity and even in patients who are mild overweight. These suggest that the onset of subclinical cardiac dysfunction occurs at a lower level of BMI than previously thought. There was significant improvement in echocardiographic and strain parameters following SWL, with surgical modality being an independent predictor of improvement in strain parameters. \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors report no relevant disclosures\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAvailability of materials and data\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGBD 2015 Risk Factors Collaborators. 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J Physiol. 2017;595(12):4027\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristoffersen C, Bollano E, Lindegaard MLS, Bartels ED, Goetze JP, Andersen CB, et al. Cardiac lipid accumulation associated with diastolic dysfunction in obese mice. Endocrinology. 2003;144(8):3483\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaffer JE. Lipotoxicity: when tissues overeat. Curr Opin Lipidol. 2003;14(3):281\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarason K, M\u0026oslash;lgaard H, Wikstrand J, Sj\u0026ouml;str\u0026ouml;m L. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol. 1999;83(8):1242\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTriposkiadis F, Xanthopoulos A, Starling RC, Iliodromitis E. Obesity, inflammation, and heart failure: links and misconceptions. Heart Fail Rev. 2022;27(2):407\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoh KK, Shabbir A, Ngiam JN, Lee PSS, So J, Frampton CM, et al. Plasma Clearance of B-Type Natriuretic Peptide (BNP) before and after Bariatric Surgery for Morbid Obesity. Clin Chem. 2021;67(4):662\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Li J, Pu H, He W, Zhou X, Tong N, et al. Cardiac remodeling and subclinical left ventricular dysfunction in adults with uncomplicated obesity: a cardiovascular magnetic resonance study. Quant Imaging Med Surg. 2022;12(3):2035\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaciejewski ML, Arterburn DE, Van Scoyoc L, Smith VA, Yancy WS, Weidenbacher HJ, et al. Bariatric Surgery and Long-term Durability of Weight Loss. JAMA Surg. 2016;151(11):1046\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClifton PM, Keogh JB. Effects of Different Weight Loss Approaches on CVD Risk. Curr Atheroscler Rep. 2018;20(6):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarso SP, Bain SC, Consoli A, Eliaschewitz FG, J\u0026oacute;dar E, Leiter LA, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375(19):1834\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2017;377(13):1228\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarx N, Husain M, Lehrke M, Verma S, Sattar N. GLP-1 Receptor Agonists for the Reduction of Atherosclerotic Cardiovascular Risk in Patients With Type 2 Diabetes. Circulation. 2022;146(24):1882\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J. 2020;41(2):255\u0026ndash;323.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJakovljevic DG, Papakonstantinou L, Blamire AM, MacGowan GA, Taylor R, Hollingsworth KG, et al. Effect of physical activity on age-related changes in cardiac function and performance in women. Circ Cardiovasc Imaging. 2015;8(1):e002086.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTernacle J, Wan F, Sawaki D, Surenaud M, Pini M, Mercedes R, et al. Short-term high-fat diet compromises myocardial function: a radial strain rate imaging study. Eur Heart J Cardiovasc Imaging. 2017;18(11):1283\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eBaseline Clinical Characteristics\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon-Surgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;66\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;12\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-Value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographics and Comorbidities\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge, years\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e38.39\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.83\u0026thinsp;\u0026plusmn;\u0026thinsp;10.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.312\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale sex, (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e59 (89.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10 (83.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.545\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension, (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (50)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHyperlipidaemia, (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (4.56)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (58.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDiabetes Mellitus, (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1.52)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (41.67)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eType of Bariatric Surgery\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eSleeve Gastrectomy, (%)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eGastric Bypass, (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN.A\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10 (83.3)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e2 (16.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eN.A\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBody Mass Index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eReduction in Body Mass Index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-10.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDifferences in Baseline Echocardiographic Parameters and Speckle Strain Parameters\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon-Surgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;66\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;12\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-Value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEchocardiographic Parameters\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter diastole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e45.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e50.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter systole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e32.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.151\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Mass Index, g/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e66.74\u0026thinsp;\u0026plusmn;\u0026thinsp;12.085\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e80.83\u0026thinsp;\u0026plusmn;\u0026thinsp;22.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRelative Wall Thickness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.338\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.385 +/ 0.032\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFractional Shortening, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e35.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.145\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Atrium, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAortic Root Diameter, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eE-Point to Septal Separation, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.144\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Ejection fraction, visual, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e65.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e62.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral Deceleration Time, msec\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e170\u0026thinsp;\u0026plusmn;\u0026thinsp;27.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e171.92\u0026thinsp;\u0026plusmn;\u0026thinsp;19.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.409\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.89\u0026thinsp;\u0026plusmn;\u0026thinsp;14.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e78.42\u0026thinsp;\u0026plusmn;\u0026thinsp;19.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.183\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral A Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e55.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e67.17\u0026thinsp;\u0026plusmn;\u0026thinsp;22.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E/A\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.378\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.716\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.10\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.109\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal A\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.339\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo;/A\u0026rsquo; Velocity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.353\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.993\u0026thinsp;\u0026plusmn;\u0026thinsp;0.463\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.11\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.490\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.605\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.175\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.321\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.961\u0026thinsp;\u0026plusmn;\u0026thinsp;0.375\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePulmonary Artery Systolic Pressure, mmHg\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.015\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.274\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSpeckle-Tracking Strain Parameters\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft ventricular global longitudinal strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-22.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-16.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight ventricular free wall strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-21.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-19.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.047\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft atrium reservoir strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e51.456\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;19.31\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eEchocardiographic and Speckle Strain Parameters at Baseline and Follow-Up\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon-surgical Weight Loss, N\u0026thinsp;=\u0026thinsp;66\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical Weight Loss, N\u0026thinsp;=\u0026thinsp;12\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eParameters\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eBaseline\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePost-Intervention (4 months)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eBaseline\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003ePost-Intervention\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(6-months)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-value\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-Value\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBody Mass Index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter diastole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e45.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e46.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e50.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e49.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.288\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.807\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter systole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e32.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.133\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.140\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Mass Index, g/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e66.74\u0026thinsp;\u0026plusmn;\u0026thinsp;12.085\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e68.47\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e80.83\u0026thinsp;\u0026plusmn;\u0026thinsp;22.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e88.42\u0026thinsp;\u0026plusmn;\u0026thinsp;23.16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.123\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.151\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRelative Wall Thickness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.338\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.333\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.385 +/ 0.032\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.386\u0026thinsp;\u0026plusmn;\u0026thinsp;0.072\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.423\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.959\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFractional Shortening, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e35.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.370\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.024\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Atrium, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e33.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.447\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.897\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAortic Root Diameter, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.469\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.551\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eE-Point to Septal Separation, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.246\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.813\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Ejection fraction, visual, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e65.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e65.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e62.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e65.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.759\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.067\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral Deceleration Time, ms\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e170\u0026thinsp;\u0026plusmn;\u0026thinsp;27.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e171.98\u0026thinsp;\u0026plusmn;\u0026thinsp;30.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e171.92\u0026thinsp;\u0026plusmn;\u0026thinsp;19.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e174.08\u0026thinsp;\u0026plusmn;\u0026thinsp;21.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.373\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.792\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.89\u0026thinsp;\u0026plusmn;\u0026thinsp;14.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.06\u0026thinsp;\u0026plusmn;\u0026thinsp;19.14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e78.42\u0026thinsp;\u0026plusmn;\u0026thinsp;19.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e85.92\u0026thinsp;\u0026plusmn;\u0026thinsp;17.89\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.279\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral A Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e55.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e54.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e67.17\u0026thinsp;\u0026plusmn;\u0026thinsp;22.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e63.25\u0026thinsp;\u0026plusmn;\u0026thinsp;25.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0277\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.305\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E/A\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.378\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.422\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.716\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.201\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.121\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.424\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal A\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.046\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.778\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo;/A\u0026rsquo; Velocity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.353\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.369\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.993\u0026thinsp;\u0026plusmn;\u0026thinsp;0.463\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.585\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.038\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.08\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.230\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.045\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.073\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.748\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.490\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.488\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.605\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.602\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.07\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.061\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.331\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.129\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.107\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.234\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.684\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.321\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.343\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.961\u0026thinsp;\u0026plusmn;\u0026thinsp;0.375\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.378\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.605\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.338\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePulmonary Artery Systolic Pressure, mmHg\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.015\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.140\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.406\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSpeckle-Tracking Strain Parameters\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft ventricular global longitudinal\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003estrain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-22.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-22.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-16.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-20.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.125\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight ventricular free wall strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-21.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-22.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-19.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-23.49\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.404\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.03\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft atrium reservoir strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e51.456\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e48.78\u0026thinsp;\u0026plusmn;\u0026thinsp;19.09\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;19.31\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e44.32\u0026thinsp;\u0026plusmn;\u0026thinsp;14.23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.190\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e1: P-value comparing Non-Surgical Weight Loss at baseline and post intervention\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e2: P-value comparing Surgical Weight Loss at baseline and post-intervention\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDifferences in Extent of Changes at Follow-Up between Non-Surgical Weight Loss and Surgical Weight Loss Cohort\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon-Surgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;66\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical Weight Loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;12\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-Value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAnthropometric\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eReduction in BMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-10.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEchocardiographic Parameters\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter diastole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.184\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.417\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.362\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Internal Diameter systole, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.345\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Mass Index, g/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.58\u0026thinsp;\u0026plusmn;\u0026thinsp;24.25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.195\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRelative Wall Thickness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.00185\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0697\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000833\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0552\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.451\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFractional Shortening, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.182\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Atrium, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.0566\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.167\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.459\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eE-Point to Septal Separation, mm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.222\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.386\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricular Ejection fraction, visual, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.316\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral Deceleration Time, ms\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;32.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;27.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.472\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;11.77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral A Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.40\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;12.62\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.333\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMitral E/A\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0393\u0026thinsp;\u0026plusmn;\u0026thinsp;0.342\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.147\u0026thinsp;\u0026plusmn;\u0026thinsp;0.250\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.163\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0547\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal A\u0026rsquo; Velocity, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.372\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.167\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.351\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E\u0026rsquo;/A\u0026rsquo; Velocity,\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0628\u0026thinsp;\u0026plusmn;\u0026thinsp;0.399\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.258\u0026thinsp;\u0026plusmn;\u0026thinsp;0.458\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.069\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Septal E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.369\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0513\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.858\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.325\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.364\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.449\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.121\u0026thinsp;\u0026plusmn;\u0026thinsp;0.376\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.162\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.369\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Lateral E/E\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.615\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.671\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.461\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.451\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.101\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle A\u0026rsquo;, cm/s\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.311\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.364\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.480\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle E\u0026rsquo;/A\u0026rsquo;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.0157\u0026thinsp;\u0026plusmn;\u0026thinsp;0.299\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0425\u0026thinsp;\u0026plusmn;\u0026thinsp;0.368\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.281\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSpeckle-Tracking Strain Parameters\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft ventricular global longitudinal strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.011\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight ventricular free wall strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.09\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft atrium reservoir strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.02\u0026thinsp;\u0026plusmn;\u0026thinsp;13.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.0386\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpeckle-Tracking Strain Parameters Between Lean vs Overweight Subjects\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eLean Subjects (N\u0026thinsp;=\u0026thinsp;10)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eOverweight Subjects (N\u0026thinsp;=\u0026thinsp;66)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge, years\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e33.92 +/- 7.6\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e38.39 +/- 8.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.112\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale sex, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (70%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e59 (89.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.09\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBody Mass Index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.4 +/- 3.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.2 +/- 2.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft ventricular global longitudinal.\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003estrain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-24.4 +/- 2.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-22.05 +/- 2.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight ventricular free wall strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-28.8 +/- 5.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-21.6 +/- 3.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft atrium reservoir strain, %\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e75.24 +/- 9.174\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e51.46 +/- 11.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eImpact of Surgical Weight Loss on Strain Parameters \u0026ndash; Structural Equation Model\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCoefficient\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e95% Confidence Interval\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Ventricle Strain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-4.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-6.46 - -1.557\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRight Ventricle Strain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.56\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.67\u0026ndash;19.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLeft Atrium Strain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-10.4\u0026ndash;3.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.364\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e1\u003c/sup\u003e Structural Equation Model has been adjusted for body mass index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obesity, Subclinical cardiac dysfunction, Echocardiography, Speckle-tracking strain parameters","lastPublishedDoi":"10.21203/rs.3.rs-4194533/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4194533/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: Surgical weight loss (SWL) improves myocardial mechanics as measured by speckle-tracking imaging. However non-surgical versus SWL and the subsequent impact on myocardial function in overweight Asian subjects has not been evaluated.\u003c/p\u003e\n\u003cp\u003eMethods:\u003cstrong\u003e \u003c/strong\u003e66 patients underwent a 16-week lifestyle intervention (LSI) programme consisting of dietary interventions and exercise prescription. Echocardiography with speckle tracking was performed at baseline and post-intervention. This group was compared against a group of 12 subjects who had undergone bariatric surgery and a control group of 10 lean Asian subjects. A generalised structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on strain parameters, adjusting for BMI.\u003c/p\u003e\n\u003cp\u003eResults: Participants attained significant weight loss after LSI (28.2±2.66 kg/m\u003csup\u003e2\u003c/sup\u003e vs 25.8±2.84 kg/m\u003csup\u003e2\u003c/sup\u003e, p=0.001). This was associated with a non-significant trend towards improvement in strain parameters. SWL participants had significant improvement in the left ventricular global longitudinal strain (-20.52±3.34 vs -16.68±4.15, p\u0026lt;0.01) and left atrium reservoir strain (44.32±14.23 vs 34.3±19.31, p=0.02). Lean subjects had significantly higher strain parameters than overweight subjects. The gSEM model demonstrated surgical modality of weight loss as an independent predictor of improvement in strain parameters.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003cstrong\u003e \u003c/strong\u003eSignificant improvement in echocardiographic parameters were documented in patients who underwent bariatric surgery.\u003c/p\u003e","manuscriptTitle":"Impact of surgical and non-surgical weight loss on echocardiographic and strain parameters in Asian patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-03 06:21:49","doi":"10.21203/rs.3.rs-4194533/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-12T08:55:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-11T18:22:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14634130785578379711138030219249796661","date":"2024-07-04T14:27:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-29T22:20:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101525685706974830521411257685663432443","date":"2024-05-24T01:36:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-28T10:26:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-28T10:22:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-28T10:07:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-28T10:03:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-03-31T07:10:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e439e06-28f7-49f5-8efc-f98ff0aff960","owner":[],"postedDate":"May 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":31362540,"name":"Health sciences/Cardiology"},{"id":31362541,"name":"Health sciences/Cardiology/Cardiovascular biology/Cardiac hypertrophy"}],"tags":[],"updatedAt":"2024-10-21T16:03:20+00:00","versionOfRecord":{"articleIdentity":"rs-4194533","link":"https://doi.org/10.1038/s41598-024-69586-y","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-10-15 15:56:51","publishedOnDateReadable":"October 15th, 2024"},"versionCreatedAt":"2024-05-03 06:21:49","video":"","vorDoi":"10.1038/s41598-024-69586-y","vorDoiUrl":"https://doi.org/10.1038/s41598-024-69586-y","workflowStages":[]},"version":"v1","identity":"rs-4194533","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4194533","identity":"rs-4194533","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}