Long-Term Changes in Cardiac Structure and Function Following Bariatric Surgery.
Long-Term Changes in Cardiac Structure and Function Following Bariatric Surgery.
复制标题
DOI：
10.1016/j.jacc.2022.08.738
复制
发表时间：
2022-10-18
影响因子：
24
通讯作者：
Borlaug, Barry A.
中科院分区：
文献类型：
--
作者：
Sorimachi, Hidemi;Obokata, Masaru;Omote, Kazunori;Reddy, Yogesh N., V;Takahashi, Naoki;Koepp, Katlyn E.;Ng, Arnold C. T.;Rider, Oliver J.;Borlaug, Barry A.
短期随访研究已经证明减肥 (WL) 对心脏有良好的影响，但关于长期影响或内脏脂肪减少的影响的信息很少。评估减肥手术后长期 WL 对心脏结构、功能、心室相互作用和身体成分的影响，包括心外膜脂肪厚度 (EAT) 和腹部内脏脂肪组织 (VAT)。 213 名肥胖患者在减肥手术前和术后 180 天以上接受了超声心动图检查。在这些患者中，n=52 例通过计算机断层扫描测量腹部 VAT 面积。 5.3（IQR 2.9-7.9）年后，BMI 下降了 22%，整个样本中的血压、空腹血糖和左室重构均出现有利的降低。在腹部 CT 患者亚组中，VAT 面积下降了 30%。在所有受试者中，EAT 降低了 14%（均 p<0.0001），同时心室相互依赖性也降低了。 WL 后 LV 和 RV 纵向应变有所改善，但左心房 (LA) 应变恶化，而 LA 体积和估计 LA 压力增加。在亚组分析中，基线时左室壁厚度和应变与 VAT 的相关性强于 BMI，手术后 LV 质量的减少与 VAT 的减少相关，但与 BMI 无关。在这项观察性研究中，减肥手术后的体重减轻与心外膜脂肪减少、心室相互作用减少、左心室逆重塑和纵向双心室力学改善有关，但左心室肌病和血流动力学充血仍在进展。内脏脂肪的减少与良好的心脏效应相关，表明这可能是 WL 干预的关键目标。我们评估了减肥手术后长期减肥的效果。中位随访 5.3 年后，BMI 下降了 22%，而 VAT 面积和 EAT 分别下降了 30% 和 14%。观察到左心室逆重塑和双心室纵向应变的改善，同时心室相互依赖性降低。然而，LA 应变降低，而 LA 体积和 E/e' 比增加。手术后左心室质量的减少与增值税的减少相关，但与体重指数的减少无关。这些数据揭示了与内脏脂肪减少相关的有利的慢性心室效应，但也表明，尽管体重大幅减轻，左心室功能障碍仍可能进展。
Studies with short-term follow up have demonstrated favorable effects of weight loss (WL) on the heart, but little information is available regarding long-term effects, or effects of visceral fat reduction. Evaluate the effects of long-term WL following bariatric surgery on cardiac structure, function, ventricular interaction, and body composition, including epicardial adipose thickness (EAT) and abdominal visceral adipose tissue (VAT). 213 obese patients underwent echocardiography before and >180 days following bariatric surgery. Of these patients, abdominal VAT-area was measured by computed tomography in n=52. After 5.3 (IQR 2.9–7.9) years, BMI decreased by 22%, with favorable reductions in blood pressure, fasting glucose, and LV remodeling in the full sample. In the subgroup of patients with abdominal CT VAT-area decreased by 30%. In all subjects, EAT was reduced by 14% (both p<0.0001) in tandem with reductions in ventricular interdependence. LV and RV longitudinal strain improved following WL, but left atrial (LA) strain deteriorated, while LA volume and estimated LA pressures increased. In subgroup analysis, LV wall thickness and strain correlated more strongly with VAT than BMI at baseline, and reductions in LV mass following surgery were correlated with decreases in VAT, but not BMI. In this observational study, weight loss following bariatric surgery was associated with epicardial fat reduction, reduced ventricular interaction, LV reverse remodeling, and improved longitudinal biventricular mechanics, but LA myopathy and hemodynamic congestion still progressed. Reduction in visceral fat was associated with favorable cardiac effects, suggesting this might be a key target of WL interventions. We evaluated the effects of long-term weight loss following bariatric surgery. After median 5.3 years follow-up, BMI decreased by 22%, while VAT-area and EAT decreased by 30% and 14%. LV reverse remodeling and improvement of biventricular longitudinal strain were observed with reductions in ventricular interdependence. However, LA strain decreased and LA volume, and E/e’ ratio increased. Reductions in LV mass following surgery were correlated with decreases in VAT, but not BMI. These data reveal favorable chronic ventricular effects tied to visceral fat reduction, but also show that LA dysfunction may still progress despite robust weight loss.
登录
查看更多内容
影响因子：
24
作者：
Owan, Theophilus;Avelar, Erick;Litwin, Sheldon E.
通讯作者：
Litwin, Sheldon E.
影响因子：
18.2
作者：
Pugliese, Nicola R.;Paneni, Francesco;Masi, Stefano
通讯作者：
Masi, Stefano
影响因子：
39.3
作者：
Melenovsky, Vojtech;Hwang, Seok-Jae;Borlaug, Barry A.
通讯作者：
Borlaug, Barry A.
DOI：
10.1001/jama.2015.17346
发表时间：
2016-01-05
期刊：
JAMA
影响因子：
--
作者：
Kitzman DW;Brubaker P;Morgan T;Haykowsky M;Hundley G;Kraus WE;Eggebeen J;Nicklas BJ
通讯作者：
Nicklas BJ
影响因子：
24
作者：
Gaborit, Benedicte;Jacquier, Alexis;Dutour, Anne
通讯作者：
Dutour, Anne