Kovac Nina, Grymyr Lisa M D, Gerdts Eva, Nadirpour Saied, Nedrebø Bjørn G, Hjertaas Johannes J, Matre Knut, Cramariuc Dana
Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.
J Clin Med. 2022 Apr 16;11(8):2237. doi: 10.3390/jcm11082237.
Background: Aortic valve sclerosis (AVS), mitral valve sclerosis (MVS), remodeling of major arteries, and increased pericardial fat are associated with subclinical atherosclerosis. We assessed these markers of atherosclerosis in severely obese patients before and 1 year after bariatric surgery. Methods: Eighty-seven severely obese patients (43 ± 10 years, preoperative body mass index [BMI] 41.8 ± 5 kg/m2) underwent echocardiography before and 1 year after Roux-en-Y bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic aortic wall thickness (AWT), pericardial fat thickness at the right ventricular free wall, and AVS/MVS based on combined aortic leaflet thickness and hyperechoic valve lesions. Results: Postoperatively, patients experienced a reduction of 12.9 ± 3.9 kg/m2 in BMI, 0.5 ± 1.9 mm in AWT, 2.6 ± 2.3 mm in pericardial fat, and 45%/53% in AVS/MVS (p < 0.05). In multivariate regression analyses with adjustment for clinical and hemodynamic variables, less pericardial fat reduction was associated with male sex and higher 1-year blood pressure and BMI, and less AWT-reduction with higher age and 1-year BMI (p < 0.05). Persistent AVS and MVS were related to higher 1-year BMI and more advanced valve sclerosis preoperatively (p < 0.05). Conclusions: Markers of subclinical atherosclerosis decreases significantly 1 year after bariatric surgery, particularly in younger patients that achieve a BMI < 28 kg/m2.
主动脉瓣硬化（AVS）、二尖瓣硬化（MVS）、主要动脉重塑和心包脂肪增加与亚临床动脉粥样硬化相关。我们评估了肥胖症手术前后严重肥胖患者的这些动脉粥样硬化标志物。方法：在“挪威西海岸肥胖症手术（FatWest）”研究中，87例严重肥胖患者（43±10岁，术前体重指数[BMI]为41.8±5kg/m²）在接受Roux-en-Y旁路手术前及术后1年接受了超声心动图检查。我们测量了舒张末期主动脉壁厚度（AWT）、右心室游离壁的心包脂肪厚度，以及基于主动脉瓣叶厚度和高回声瓣膜病变综合评估的AVS/MVS。结果：术后，患者的BMI降低了12.9±3.9kg/m²，AWT降低了0.5±1.9mm，心包脂肪降低了2.6±2.3mm，AVS/MVS降低了45%/53%（p<0.05）。在对临床和血流动力学变量进行调整的多变量回归分析中，心包脂肪减少较少与男性性别、1年时较高的血压和BMI相关，而AWT减少较少与较高的年龄和1年时的BMI相关（p<0.05）。持续性AVS和MVS与1年时较高的BMI和术前更严重的瓣膜硬化相关（p<0.05）。结论：肥胖症手术后1年，亚临床动脉粥样硬化标志物显著降低，尤其是在BMI<28kg/m²的年轻患者中。
