心脏 MRI 测量肥胖症患者无心脏病史行 Roux-en-Y 胃旁路手术后心功能的改善。
Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI.
机构信息
Department of Radiology, Maasstad Hospital, Rotterdam, the Netherlands.
Department of Radiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
出版信息
Obes Surg. 2020 Jul;30(7):2475-2481. doi: 10.1007/s11695-020-04543-y.
PURPOSE
Metabolic syndrome in patients with morbid obesity causes a higher cardiovascular morbidity, eventually leading to left ventricular hypertrophy and decreased left ventricular ejection fraction (LVEF). Roux-en-Y gastric bypass (RYGB) is considered the gold standard modality for treatment of morbid obesity and might even lead to improved cardiac function. Our objective is to investigate whether cardiac function in patients with morbid obesity improves after RYGB.
MATERIALS AND METHODS
In this single center pilot study, 15 patients with an uneventful cardiac history who underwent RYGB were included from May 2015 to March 2016. Cardiac function was measured by cardiac magnetic resonance imaging (CMRI), performed preoperatively and 3, 6, and 12 months postoperative. LVEF and myocardial mass and cardiac output were measured.
RESULTS
A total of 13 patients without decreased LVEF preoperative completed follow-up (mean age 37, 48.0 ± 8.8). There was a significant decrease of cardiac output 12 months postoperative (8.3 ± 1.8 preoperative vs. 6.8 ± 1.8 after 12 months, P = 0.001). Average myocardial mass declined by 15.2% (P < 0.001). After correction for body surface area (BSA), this appeared to be non-significant (P = 0.36). There was a significant improvement of LVEF/BSA at 6 and 12 months postoperative (26.2 ± 4.1 preoperative vs. 28.4 ± 3.4 and 29.2 ± 3.6 respectively, both P = 0.002). Additionally, there was a significant improvement of stroke volume/BSA 12 months after surgery (45.8 ± 8.0 vs. 51.9 ± 10.7, P = 0.033).
CONCLUSION
RYGB in patients with morbid obesity with uneventful history of cardiac disease leads to improvement of cardiac function.
目的
病态肥胖患者的代谢综合征会导致更高的心血管发病率，最终导致左心室肥厚和左心室射血分数（LVEF）降低。Roux-en-Y 胃旁路（RYGB）被认为是治疗病态肥胖的金标准方法，甚至可能导致心脏功能改善。我们的目的是研究病态肥胖患者 RYGB 后心脏功能是否改善。
材料和方法
在这项单中心的初步研究中，我们纳入了 2015 年 5 月至 2016 年 3 月期间接受 RYGB 的 15 例无心脏病史的患者。术前及术后 3、6 和 12 个月，通过心脏磁共振成像（CMRI）测量心脏功能。测量 LVEF、心肌质量和心输出量。
结果
共有 13 例术前 LVEF 未降低的患者完成了随访（平均年龄 37 岁，48.0±8.8）。术后 12 个月心输出量显著降低（术前 8.3±1.8 与术后 12 个月 6.8±1.8，P=0.001）。平均心肌质量下降 15.2%（P<0.001）。校正体表面积（BSA）后，这似乎没有统计学意义（P=0.36）。术后 6 个月和 12 个月 LVEF/BSA 显著改善（术前 26.2±4.1 与术后 28.4±3.4 和 29.2±3.6，均 P=0.002）。此外，术后 12 个月时，每搏输出量/BSA 也显著增加（45.8±8.0 与 51.9±10.7，P=0.033）。
结论
病态肥胖且无心脏疾病病史的患者接受 RYGB 可改善心脏功能。
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