Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction.

Background Obesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity. Methods and Results Patients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m2 were offered enrollment in an established 15-week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6-minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m2), 74% of whom lost >5% of their baseline body weight following the 15-week program. At 15 weeks, mean 6-minute walk distance increased from 223 to 281 m (P=0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks (P<0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score (r=0.452; P=0.000) and 6-minute walk distance (r=-0.388; P<0.001). Conclusions In a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15-week program. This is associated with significant improvements in quality of life and exercise capacity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02911337.

Comparative photoactivity and stability of isolated cyanobacterial monomeric and trimeric Photosystem I.

Photoactivity of native trimeric, and non-native monomeric Photosystem I (PSI) extracted from Thermosynechococcus elongatus is compared in a photoelectrochemical system. The PSI monomer is isolated by disassembling a purified PSI trimer using a freeze-thaw technique in presence of the short-chain surfactant, octylthioglucoside. Photoactive electrodes are constructed with PSI, functioning as both light absorber and charge-separator, embedded within a conductive polymer film. Despite structural differences between PSI trimers and monomers, electrodes cast with equal chlorophyll-a concentration generate similar photoactivities. Photoaction spectra show that all photocurrent derived from electrodes of PSI and conductive polymer originates solely from PSI with no photocurrent caused by redox mediators in the conductive polymer film. Longevity studies show that the two forms of PSI photodegrade at the same rate while exposed to equal intensities of 676 nm light. Direct photo-oxidation measurements indicate that PSI's monomeric form has fewer light harvesting antennae than trimer, and also shows energy sharing between monomeric subunits in the trimer. The structure of PSI is also found to impact cell performance when applying light at incident powers above 1.5 mW/cm(2) due to the reduced optical cross-section in the monomer, causing saturation at lower light intensities than the trimer.