Favorable Changes in Cardiac Geometry and Function Following Gastric Bypass Surgery 2-Year Follow-Up in the Utah Obesity Study
Favorable Changes in Cardiac Geometry and Function Following Gastric Bypass Surgery 2-Year Follow-Up in the Utah Obesity Study
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DOI：
10.1016/j.jacc.2010.10.017
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发表时间：
2011-02-08
影响因子：
24
通讯作者：
Litwin, Sheldon E.
中科院分区：
文献类型：
--
作者：
Owan, Theophilus;Avelar, Erick;Litwin, Sheldon E.
目的本研究的目的是验证胃旁路手术（GBS）对心脏重构和功能有积极影响的假设。背景GBS越来越多地用于治疗严重肥胖，方法我们前瞻性研究了423例接受GBS的严重肥胖患者和一组未接受手术的严重肥胖受试者（n = 733）。随访1年，与对照组相比，GBS受试者的体重指数显著降低（-15.4 +/- 7.2 kg/m2 vs. -0.03 +/- 4.0 kg/m2; p < 0.0001），腰围、收缩压、心率、甘油三酯、低密度脂蛋白胆固醇和胰岛素抵抗也显著降低。高密度脂蛋白胆固醇升高。GBS组左心室（LV）质量指数和右心室（RV）腔面积减少。GBS患者的左心房容积没有变化，但参考受试者的左心房容积增加。与减小的心腔尺寸相结合，GBS受试者的左心室中壁缩短分数和右心室面积变化分数也增加。在多变量分析中，年龄，体重指数的变化，夜间低氧血症的严重程度，E/E '，和性别与LV质量指数独立相关，而手术状态，腰围的变化，和胰岛素抵抗的变化没有。这些数据支持使用减肥手术来预防严重肥胖患者的心血管并发症。（J Am科尔心脏病学杂志2011;57：732-9）（C）美国心脏病学会基金会2011年
Objectives The objective of this study was to test the hypothesis that gastric bypass surgery (GBS) would favorably impact cardiac remodeling and function.Background GBS is increasingly used to treat severe obesity, but there are limited outcome data.Methods We prospectively studied 423 severely obese patients undergoing GBS and a reference group of severely obese subjects that did not have surgery (n = 733).Results At a 2-year follow up, GBS subjects had a large reduction in body mass index compared with the reference group (-15.4 +/- 7.2 kg/m(2) vs. -0.03 +/- 4.0 kg/m(2); p < 0.0001), as well as significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density lipoprotein cholesterol, and insulin resistance. High-density lipoprotein cholesterol increased. The GBS group had reductions in left ventricular (LV) mass index and right ventricular (RV) cavity area. Left atrial volume did not change in GBS but increased in reference subjects. In conjunction with reduced chamber sizes, GBS subjects also had increased LV midwall fractional shortening and RV fractional area change. In multivariable analysis, age, change in body mass index, severity of nocturnal hypoxemia, E/E', and sex were independently associated with LV mass index, whereas surgical status, change in waist circumference, and change in insulin resistance were not.Conclusions Marked weight loss in patients undergoing GBS was associated with reverse cardiac remodeling and improved LV and RV function. These data support the use of bariatric surgery to prevent cardiovascular complications in severe obesity. (J Am Coll Cardiol 2011;57:732-9) (C) 2011 by the American College of Cardiology Foundation