Mostfa Shaimaa Ahmed
Cardiovascular Department, Benha Faculty of Medicine, Benha Univerisity, Egypt.
Indian Heart J. 2018 Dec;70 Suppl 3(Suppl 3):S224-S228. doi: 10.1016/j.ihj.2018.01.012. Epub 2018 Jan 9.
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.
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.
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.
Obesity adversely affects cardiac function independent of obesity-related comorbidities .Weight reduction significantly increase the systolic and diastolic function of both ventricles.
肥胖对心脏代谢危险因素和糖尿病发病的影响此前已得到证实，但体重变化对独立于肥胖相关合并症的心脏结构的影响尚未得到广泛研究。目的：研究肥胖及手术减重对心脏结构的影响。
纳入52例体重指数（BMI）≥40kg/m²、无既往或明显心脏危险因素及疾病的患者，所有患者均接受了减重手术；术前及术后6个月进行常规超声心动图（二维、M型、多普勒）、组织多普勒速度（TDI）、应变及斑点追踪超声心动图检查左、右心室。
平均年龄为38.2±5.6岁，BMI为42.3±3.4kg/m²，65%为女性，35%为男性。术后6个月；左心室收缩末期容积（LVESV）和左心室舒张末期容积（LVEDV）显著增加，分别从66.57±22增加至37.2±12，p<0.001，以及从169.4±43.2增加至120.36±19.6ml，p<0.001，射血分数（EF%）从59±8增加至67±7ml，p<0.001，左心室质量指数（LVMI）显著降低，从143±11降至95.5±7g/m²，p<0.001。右心室收缩面积（RVSA）从16.3±4.1显著增加至10.1±2.7cm²，p<0.001，但右心室舒张面积（RVDA）从30.2±1.5至26.7±2cm²无显著变化，p=0.05，面积变化分数（FAC）从49.5±2.1至52±1.2%，p=0.7，三尖瓣环平面收缩期位移（TAPSE）从20.3±2.8至22.6±3.5mm，p=0.56，肺动脉收缩压（PASP）从32.2±5.2至29.2±2.1mmHg，p=0.81。左心室早期组织多普勒舒张速度（Em）从7.1±2.1增加至12±3.5，p<0.001，右心室从6.2±2.8增加至9.2±'1.4，p=0.05，左、右心室组织多普勒应变分别从-16.1±2.5增加至-22.8±3.1，p<0.001，从-11.2±2.6增加至-17.3±3.4，p<0.001。左心室纵向收缩应变（LVLPSS）从-17.2±2.1增加至-22.7±3.9，p<0.001，右心室纵向收缩应变（RVLPSS）从-12.8±1.5增加至-18.1±2.7，p<0.001。
肥胖独立于肥胖相关合并症对心脏功能产生不利影响。减重显著增加了双心室的收缩和舒张功能。
