Department of Mechanical and Aerospace Engineering, Brunel University London, Kingston Lane, Uxbridge, Middlesex, UB8 3PH, UK.
Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Tuscany, Italy.
Obes Surg. 2020 Oct;30(10):3776-3783. doi: 10.1007/s11695-020-04686-y.
Obesity clearly increases cardiovascular risk, often inducing high blood pressure (BP), impaired left ventricular (LV) function, and increased arterial stiffness. Intensive weight loss and bariatric surgery induce improvement in hypertension and diabetes for morbid obesity. Carotid artery haemodynamics is a powerful prognostic indicator for stroke and cognitive decline independent of BP. The aim of this study was to evaluate the impact of a 3-stage bariatric strategy of diet, bariatric surgery, and consequent weight loss on carotid haemodynamics and cardiac diastolic function.
This prospective study included 26 patients (45 ± 10 years, 4 men) with severe obesity undergoing bariatric surgery without comorbidities (hypertension, diabetes, etc.). Anthropometry, BP, Doppler echocardiography, and common carotid haemodynamics by ultrasound were measured at three times: (1) baseline, (2) after 1-month diet (post-diet), and (3) 8 months after surgery (post-surgery). The lnDU-loop method was used to estimate local carotid pulse wave velocity (PWV).
Baseline BMI was 47.9 ± 7.1 kg/m and reduced by 5% and 30% post-diet and post-surgery, respectively. BP decreased only post-diet, without pulse pressure change. However, PWV, 6.27 ± 1.35 m/s at baseline, was significantly reduced by 10% and 23% post-diet and post-surgery, respectively, also adjusted for BP changes. The E/A ratio rose from 0.95 ± 0.20 to 1.27 ± 0.31 (p < 0.005), without change in LV geometry or mass, while heart rate and cardiac output fell substantially.
Weight loss following diet and bariatric surgery is associated with reduced carotid arterial stiffness and improved LV diastolic function. Diet and bariatric surgery are effective treatments for morbid obesity with its concomitant adverse cardiovascular effects.
肥胖明显增加心血管风险，常导致高血压（BP）、左心室（LV）功能障碍和动脉僵硬度增加。重度肥胖患者的强化减重和减重手术可改善高血压和糖尿病。颈动脉血流动力学是独立于 BP 预测中风和认知能力下降的有力预后指标。本研究旨在评估饮食、减重手术和随后的体重减轻 3 阶段减重策略对颈动脉血流动力学和心脏舒张功能的影响。
本前瞻性研究纳入了 26 名（45±10 岁，4 名男性）无合并症（高血压、糖尿病等）的严重肥胖患者行减重手术。在 3 个时间点测量了人体测量学、BP、多普勒超声心动图和超声颈动脉血流动力学：（1）基线，（2）饮食后 1 个月（post-diet），（3）手术后 8 个月（post-surgery）。使用 lnDU 环法估计局部颈动脉脉搏波速度（PWV）。
基线 BMI 为 47.9±7.1kg/m2，饮食后和手术后分别降低了 5%和 30%。BP 仅在饮食后下降，而脉压没有变化。然而，PWV（基线时为 6.27±1.35m/s）在饮食后和手术后分别降低了 10%和 23%，且调整了 BP 变化。E/A 比值从 0.95±0.20 增加到 1.27±0.31（p<0.005），LV 几何形状或质量没有变化，而心率和心输出量显著下降。
饮食和减重手术后的体重减轻与颈动脉动脉僵硬度降低和 LV 舒张功能改善相关。饮食和减重手术是治疗肥胖及其并发的不良心血管影响的有效方法。
