Left Ventricular Structural and Functional Changes in Obese Subjects With Preserved Left Ventricular Ejection Fraction After Bariatric Surgery: Assessment With Cardiac Magnetic Resonance Imaging
Abstract
Objective To investigate the longitudinal changes in left ventricular (LV) structure and function after bariatric surgery in obese individuals and their relationship with preoperative left ventricular ejection fraction (LVEF) by cardiac magnetic resonance (CMR) imaging.
Methods We prospectively enrolled 75 obese subjects scheduled for laparoscopic sleeve gastrectomy and 46 age and sex-matched healthy controls (the control group). All subjects underwent CMR examination to obtain LV structural parameters, LVEF, and strain parameters. According to their preoperative LVEF, the obese subjects were divided into two obesity groups, including the group of patients with LVEF≥60% (n=43) and the group of patients with 50%≤LVEF<60% (n=32). LV structural and functional differences between the control group and the two obesity groups were compared. Eventually, 38 obese subjects completed the CMR follow-up at 1 month and 12 months after bariatric surgery. The longitudinal changes in LV structure and function after surgery in the LVEF≥60% (n=20) group and the 50%≤LVEF<60% group (n=18) were compared.
Results Before bariatric surgery, the global longitudinal strain was significantly lower in the LVEF≥60% group than that in the control group ([－18.36±1.86]% vs. [－19.50±1.53]%, P<0.05). The global radial ([27.70±3.52]% vs. [34.44±4.11]%, P<0.05), circumferential ([－17.35±1.46]% vs. [－19.85±1.42]%, P<0.05), and longitudinal ([－16.22±1.81]% vs. [－19.50±1.53]%, P<0.05) strain in the 50%≤LVEF<60% group was significantly lower than that in the control group. At 12 months after bariatric surgery, the global radial ([32.52±7.84]% vs. [30.92±4.27]%, P>0.05), circumferential ([－19.02±2.42]% vs. [－18.63±1.49]%, P>0.05), and longitudinal ([－18.18±2.06]% vs. [－17.78±1.66]%, P>0.05) strain in the LVEF≥60% group showed no significant difference compared with the baseline findings. In the 50%≤LVEF<60% group, the global radial ([32.73±5.86]% vs. [26.83±4.85]%, P<0.05) and circumferential ([－19.10±2.00]% vs. [－16.91±2.09]%, P<0.05) strain was significantly higher than that before surgery.
Conclusion LV remodeling is reversed after bariatric surgery in obese subjects, and the longitudinal changes in LV structure and function vary with the preoperative LVEF.
Keywords: Magnetic resonance imaging, Left ventricle, Myocardial strain, Bariatric surgery
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RUANO-CAMPOS A, CRUZ-UTRILLA A, LÓPEZ-ANTOÑANZAS L, et al. Evaluation of myocardial function following SADI-S. Obes Surg, 2021, 31(7): 3109-3115. doi: 10.1007/s11695-021-05349-2.
PAN X F, WANG L, PAN A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392. doi: 10.1016/s2213-8587(21)00045-0.
POWELL-WILEY T M, POIRIER P, BURKE L E, et al. Obesity and cardiovascular disease: a scientific statement from the american heart association. Circulation, 2021, 143(21): e984-e1010. doi: 10.1161/cir. 0000000000000973.
WU J, CHIEN S C, CHANDRAMOULI C, et al. Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: a cohort study. PLoS Med, 2021, 18(6): e1003661. doi: 10. 1371/journal.pmed.1003661.
FREA S, ANDREIS A, SCARLATTA V, et al. Subclinical left ventricular dysfunction in severe obesity and reverse cardiac remodeling after bariatric surgery. J Cardiovasc Echogr, 2020, 30(1): 22-28. doi: 10.4103/jcecho.jcecho_50_19.
ÜNLÜ S, TAÇOY G. Early adulthood obesity is associated with impaired left ventricular and right ventricular functions evaluated by speckle tracking and 3D echocardiography. Turk Kardiyol Dern Ars, 2021, 49(4): 312-313. doi: 10.5543/tkda.2021.57336.
ZENG Q, LI N, PAN X F, et al. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 393-405. doi: 10. 1016/s2213-8587(21)00047-4.
DASILVA-DEABREU A, ALHAFEZ B A, LAVIE C J, et al. Interactions of hypertension, obesity, left ventricular hypertrophy, and heart failure. Curr Opin Cardiol, 2021, 36(4): 453-460. doi: 10.1097/hco.0000000000000868.
DOUMOURAS A G, HONG D, LEE Y, et al. Association between bariatric surgery and all-cause mortality: a population-based matched cohort study in a universal health care system. Ann Intern Med, 2020, 173(9): 694-703. doi: 10.7326/m19-3925.
SANTOS E C L, DEL CASTILLO J M, PARENTE G B O, et al. Changes in left ventricular mechanics after sleeve gastrectomy. Obes Surg, 2019, 30(2): 580-586. doi: 10.1007/s11695-019-04216-5.
AGGARWAL R, HARLING L, EFTHIMIOU E, et al. The effects of bariatric surgery on cardiac structure and function: a systematic review of cardiac imaging outcomes. Obes Surg, 2015, 26(5): 1030-1040. doi: 10. 1007/s11695-015-1866-5.
CUSPIDI C, RESCALDANI M, TADIC M, et al. Effects of bariatric surgery on cardiac structure and function: a systematic review and Meta-Analysis. Am J Hypertens, 2013, 27(2): 146-156. doi: 10.1093/ajh/hpt215.
KAIER T E, MORGAN D, GRAPSA J, et al. Ventricular remodelling post-bariatric surgery: is the type of surgery relevant? A prospective study with 3D speckle tracking. Eur Heart J Cardiovasc Imaging, 2014, 15(11): 1256-1262. doi: 10.1093/ehjci/jeu116.
NAKAGAWA A, YASUMURA Y, YOSHIDA C, et al. Predictors and outcomes of heart failure with preserved ejection fraction in patients with a left ventricular ejection fraction above or below 60%. J Am Heart Assoc, 2022, 11(15): e025300. doi: 10.1161/jaha.122.025300.
SOLOMON S D, CLAGGETT B, LEWIS E F, et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Euro Heart J, 2016, 37(5): 455-462. doi: 10.1093/eurheartj/ehv464.
ROSCH S, KRESOJA K P, BESLER C, et al. Characteristics of heart failure with preserved ejection fraction across the range of left ventricular ejection fraction. Circulation, 2022, 146(7): 506-518. doi: 10.1161/circulationaha.122.059280.
LIU J, LI J, PU H, 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): 2035-2050. doi: 10.21037/qims-21-724.
HE J, YANG W, WU W, et al. Clinical features, myocardial strain and tissue characteristics of heart failure with preserved ejection fraction in patients with obesity: a prospective cohort study. EClinicalMedicine, 2022, 55: 101723. doi: 10.1016/j.eclinm.2022.101723.
PENG J, ZHAO X, ZHAO L, et al. Normal values of myocardial deformation assessed by cardiovascular magnetic resonance feature tracking in a healthy chinese population: a multicenter study. Front Physiol, 2018, 9: 1181. doi: 10.3389/fphys.2018.01181.
KAMMERLANDER A A. Feature tracking by cardiovascular magnetic resonance imaging: the new gold standard for systolic function?. JACC Cardiovasc Imaging, 2020, 13(4): 948-950. doi: 10.1016/j.jcmg.2019.11. 015.
ZHU L, GU S, WANG Q, et al. Left ventricular myocardial deformation: a study on diastolic function in the Chinese male population and its relationship with fat distribution. Quant Imaging Med Surg, 2020, 10(3): 634-645. doi: 10.21037/qims.2020.01.16.
Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of obesity: practice version (2019). Chin J Gen Pract, 2020, 19(2): 102-107. doi: 10.3760/cma.j.issn.1671-7368.2020.02.003.
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