Aggarwal Ravi, Harling Leanne, Efthimiou Evangelos, Darzi Ara, Athanasiou Thanos, Ashrafian Hutan
The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College Healthcare NHS Trust at St Mary's Hospital, Praed Street, London, W2 1NY, UK.
Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
Obes Surg. 2016 May;26(5):1030-40. doi: 10.1007/s11695-015-1866-5.
Obesity is associated with cardiac dysfunction, atherosclerosis, and increased cardiovascular risk. It can be lead to obesity cardiomyopathy and severe heart failure, which in turn raise morbidity and mortality while carrying a negative impact on quality of life. There is increasing clinical and mechanistic evidence on the metabolic and weight loss effects of bariatric surgery on improving cardiac structure and function in obese patients.
The objective of this study was to quantify the effects of bariatric surgery on cardiac structure and function by appraising cardiac imaging changes before and after metabolic operations.
This is a comprehensive systematic review of studies reporting pre-operative and post-operative echocardiographic or magnetic resonance cardiac indices in obese patients undergoing bariatric surgery. Studies were quality scored, and data were meta-analyzed using random effects modeling.
Bariatric surgery is associated with significant improvements in the weighted incidence of a number of cardiac indices including a decrease in left ventricular mass index (11.2%, 95% confidence intervals (CI) 8.2-14.1%), left ventricular end-diastolic volume (13.28 ml, 95% CI 5.22-21.34 ml), and left atrium diameter (1.967 mm, 95% CI 0.980-2.954). There were beneficial increases in left ventricular ejection fraction (1.198%, 95%CI -0.050-2.347) and E/A ratio (0.189%, 95%CI -0.113-0.265).
Bariatric surgery offers beneficial cardiac effects on diastolic function, systolic function, and myocardial structure in obese patients. These may derive from surgical modulation of an enterocardiac axis. Future studies must focus on higher evidence levels to better identify the most successful bariatric approaches in preventing and treating the broad spectrum of obesity-associated heart disease while also enhancing treatment strategies in the management of obesity cardiomyopathy.
肥胖与心脏功能障碍、动脉粥样硬化以及心血管风险增加有关。它可导致肥胖性心肌病和严重心力衰竭，进而增加发病率和死亡率，同时对生活质量产生负面影响。关于减肥手术对改善肥胖患者心脏结构和功能的代谢及减重效果，临床和机制方面的证据越来越多。
本研究的目的是通过评估代谢手术前后的心脏成像变化，量化减肥手术对心脏结构和功能的影响。
这是一项对报告接受减肥手术的肥胖患者术前和术后超声心动图或磁共振心脏指标的研究进行的全面系统评价。对研究进行质量评分，并使用随机效应模型对数据进行荟萃分析。
减肥手术与许多心脏指标的加权发生率显著改善相关，包括左心室质量指数降低（11.2%，95%置信区间（CI）8.2 - 14.1%）、左心室舒张末期容积减少（13.28 ml，95%CI 5.22 - 21.34 ml）和左心房直径减小（1.967 mm，95%CI 0.980 - 2.954）。左心室射血分数（1.198%，95%CI -0.050 - 2.347）和E/A比值（0.189%，95%CI -0.113 - 0.265）有有益增加。
减肥手术对肥胖患者的舒张功能、收缩功能和心肌结构有有益的心脏影响。这些可能源于肠心轴的手术调节。未来的研究必须聚焦于更高的证据水平，以更好地确定预防和治疗广泛的肥胖相关心脏病最成功的减肥方法，同时也加强肥胖性心肌病管理中的治疗策略。
