Impact of obesity and surgical weight reduction on cardiac remodeling.

BACKGROUND

the implication of obessity on cardiometabolic risk factors and incident diabetes has been previously demonstrated, but the impact of weight changes on cardiac structure independent of obesity-related comorbidities has not been extensively studied AIM: to study impact of obesity and surgical weight reduction on cardiac structure.

PATIENTS AND METHODS

fifty two patients withbody mass index (BMI) ≥40kg/m, free of previous or overt cardiac risk factors and diseases were included, all patients underwent bariatric surgery; Conventional echocardiography (2D, M-Mode, Doppler), tissue Doppler velocity (TDI), strain and speckle tracking echocardiography for left and right ventricles were performed before and 6m after surgery.

RESULTS

mean age was 38.2±5.6, BMI 42.3±3.4kg/m, 65% were female and 35% were male. 6 months postopeatively; there was significant increase of left ventricular end systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV) from 66.57±22 to 37.2±12 p<0.001, and 169.4±43.2 to 120.36±19.6ml with p<0.001 respectively and increased ejection fraction (EF%) from 59±8 to 67±7ml p<0.001, significant reduction in left ventricular mass index (LVMI) from 143±11 to 95.5±7gm/m p<0.001. Significant increase in right ventricular systolic area (RVSA) from 16.3±4.1 to 10.1±2.7cm p<0.001 but was insignificant in right ventricular diastolic area (RVDA) from 30.2±1.5 to 26.7±2cm p=0.05, fraction area change (FAC) from 49.5±2.1 to 52±1.2% p=0.7, Tricuspid annular plane systolic exertion (TAPSE) from 20.3±2.8to22.6±3.5mm, p=0.56and pulmonary arterty systolic pressure (PASP) from 32.2±5.2 to 29.2±2.1mmHg, p=0.81.Early tissue Doppler diastolic velocity (Em) of the LV increased from 7.1±2.1 to12±3.5 p<0.001 and that of RV from 6.2±2.8 to 9.2±1.4, p=0.05 and tissue Doppler strain of the LV and RV invrased from -16.1±2.5 to -22.8±3.1, p<0.001, -11.2± 2.6 to -17.3±3.4, p<0.001 respectively. Left ventricular longtiduinal systolic strain (LVLPSS) increased from -17.2±2.1 to -22.7±3.9 p<0.001 and right ventricular longtiduinal systolic strain (RVLPSS) increased from -12.8±1.5 to -18.1±2.7 p<0.001.

CONCLUSION

Obesity adversely affects cardiac function independent of obesity-related comorbidities .Weight reduction significantly increase the systolic and diastolic function of both ventricles.