Luaces María, Cachofeiro Victoria, García-Muñoz-Najar Alejandro, Medina Manuel, González Noemí, Cancer Emilia, Rodríguez-Robles Azucena, Cánovas Gloria, Antequera-Pérez Alfonso
Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
Rev Esp Cardiol (Engl Ed). 2012 Jan;65(1):14-21. doi: 10.1016/j.recesp.2011.06.018. Epub 2011 Oct 19.
Cardiac adaptation to obesity includes both structural and functional changes in the heart. The therapeutic option of last resort for morbidly obese patients is bariatric surgery. This study aims to assess the anatomical functional changes in the heart for a Spanish cohort of morbidly obese patients, as well as changes after bariatric surgery.
Patients referred for bariatric surgery were prospectively included. In each case, a transthoracic echocardiography, electrocardiogram, and blood tests were performed before the procedure and repeated 1 year after surgery.
Forty-one patients completed the 1-year follow-up. Of these, 82.9% were female. Mean age was 40.2±9.6 years. Prior to surgery, mean body mass index was 47.41 kg/m(2), decreasing to 30.43 kg/m(2) after the procedure. Before surgery, cardiac remodeling was present in 70.7%, most frequently in the form of eccentric hypertrophy (34.1%). At 1-year follow-up, 58.5% showed a normal left ventricular geometric pattern (P=.02). Mitral inflow E/A ratio changed from 1.14 to 1.43 (P<.001). Nevertheless, early mitral velocity measured by Doppler tissue decreased (P=.06).
In morbidly obese patients referred for bariatric surgery, cardiac remodeling is highly prevalent, in most cases in an eccentric manner. Weight loss achieved by bariatric surgery is accompanied by significant improvements in left ventricular structure. Nevertheless, the damage in diastolic function may be permanent despite weight loss.
心脏对肥胖的适应性变化包括心脏结构和功能的改变。对于病态肥胖患者，最后 resort 的治疗选择是减肥手术。本研究旨在评估一组西班牙病态肥胖患者心脏的解剖功能变化以及减肥手术后的变化。
前瞻性纳入拟行减肥手术的患者。在每种情况下，术前均进行经胸超声心动图、心电图和血液检查，并在术后 1 年重复检查。
41 例患者完成了 1 年的随访。其中，82.9%为女性。平均年龄为 40.2±9.6 岁。术前平均体重指数为 47.41kg/m²，术后降至 30.43kg/m²。术前，70.7%存在心脏重塑，最常见的形式是离心性肥厚（34.1%）。在 1 年随访时，58.5%显示左心室几何形态正常（P = 0.02）。二尖瓣流入 E/A 比值从 1.14 变为 1.43（P < 0.001）。然而，通过多普勒组织测量的二尖瓣早期速度降低（P = 0.06）。
在拟行减肥手术的病态肥胖患者中，心脏重塑非常普遍，大多数情况下呈离心性。减肥手术实现的体重减轻伴随着左心室结构的显著改善。然而，尽管体重减轻，舒张功能损害可能是永久性的。
