Gherbesi Elisa, Cuspidi Cesare, Faggiano Andrea, Sala Carla, Carugo Stefano, Tadic Marijana
Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, 20122 Milan, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy.
J Clin Med. 2022 Aug 9;11(16):4655. doi: 10.3390/jcm11164655.
Aim: Current evidence on the effects of bariatric surgery on cardiac mechanics in patients with obesity is based on a few single studies. We investigated this issue through a meta-analysis of speckle tracking echocardiography (STE) studies that reported data on changes in left ventricular (LV) mechanics as assessed by global longitudinal strain (GLS). Methods: The PubMed, OVID-MEDLINE and Cochrane library databases were systematically analysed to search English-language articles published from inception to 31 May 2022. Studies were identified by using Me-SH terms and crossing the following terms: “obesity”, “bariatric surgery”, “left ventricular mechanics”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “echocardiography” and “STE echocardiography”. Results: The meta-analysis, including a total of 512 patients with obesity from 13 studies (follow-up 1−23 months), showed a significant GLS improvement after bariatric procedures, with standard mean difference (SMD) being 0.50 ± 0.08, CI: 0.34/0.65, p < 0.0001. Corresponding SMD value for LV ejection fraction (LVEF) was 0.15 ± 0.09, CI: −0.04/0.34, p = 0.11. A sensitivity analysis restricted to 11 studies with follow-up ≥ 6 months confirmed that GLS (SMD: 0.47 ± 0.08, CI: 0.30/0.63, p < 0.0001) but not LVEF (SMD: 0.14 ± 0.11, CI: −0.08/0.37, p = 0.21) improved after surgery. Conclusions: Our meta-analysis adds a new piece of information on the beneficial effects of bariatric surgery on LV systolic function and, more importantly, suggests that the assessment of myocardial strain should be routinely implemented for a comprehensive evaluation of cardiac functional changes associated with bariatric procedures.
目前关于减肥手术对肥胖患者心脏力学影响的证据基于少数单项研究。我们通过对斑点追踪超声心动图（STE）研究进行荟萃分析来调查这一问题，这些研究报告了通过整体纵向应变（GLS）评估的左心室（LV）力学变化数据。方法：系统分析了PubMed、OVID - MEDLINE和Cochrane图书馆数据库，以检索从创刊至2022年5月31日发表的英文文章。通过使用医学主题词（Me - SH）并交叉以下术语来确定研究：“肥胖症”、“减肥手术”、“左心室力学”、“左心室肥厚”、“收缩功能障碍”、“整体纵向应变”、“超声心动图”和“STE超声心动图”。结果：荟萃分析共纳入了来自13项研究的512例肥胖患者（随访1 - 23个月），结果显示减肥手术后GLS有显著改善，标准平均差（SMD）为0.50±0.08，CI：0.34/0.65，p < 0.0001。左心室射血分数（LVEF）的相应SMD值为0.15±0.09，CI： - 0.04/0.34，p = 0.11。对随访≥6个月的11项研究进行的敏感性分析证实，术后GLS（SMD：0.47±0.08，CI：0.30/0.63，p < 0.0001）有所改善，但LVEF（SMD：0.14±0.11，CI： - 0.08/0.37，p = 0.21）未改善。结论：我们的荟萃分析为减肥手术对左心室收缩功能的有益影响增添了新的信息，更重要的是，表明应常规进行心肌应变评估，以全面评估与减肥手术相关的心脏功能变化。
