Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2022 Oct 18;80(16):1501-1512. doi: 10.1016/j.jacc.2022.08.738.
Studies with short-term follow-up have demonstrated favorable effects of weight loss (WL) on the heart, but little information is available regarding long-term effects or effects of visceral fat reduction.
The purpose of this study was to evaluate the effects of long-term WL following bariatric surgery on cardiac structure, function, ventricular interaction, and body composition, including epicardial adipose thickness and abdominal visceral adipose tissue (VAT).
A total of 213 obese patients underwent echocardiography before and >180 days following bariatric surgery. Abdominal VAT area was measured by computed tomography in 52 of these patients.
After 5.3 years (IQR: 2.9-7.9 years), body mass index (BMI) decreased by 22%, with favorable reductions in blood pressure, fasting glucose, and left ventricular (LV) remodeling in the full sample. In the subgroup of patients with abdominal computed tomography, VAT area decreased by 30%. In all subjects, epicardial adipose thickness was reduced by 14% (both P < 0.0001) in tandem with reductions in ventricular interdependence. LV and right ventricular longitudinal strain improved following WL, but left atrial (LA) strain deteriorated, while LA volume and estimated LA pressures increased. In subgroup analysis, LV wall thickness and strain correlated more strongly with VAT than BMI at baseline, and reductions in LV mass following surgery were correlated with decreases in VAT, but not BMI.
In this observational study, weight loss following bariatric surgery was associated with epicardial fat reduction, reduced ventricular interaction, LV reverse remodeling, and improved longitudinal biventricular mechanics, but LA myopathy and hemodynamic congestion still progressed. Reduction in visceral fat was associated with favorable cardiac effects, suggesting this might be a key target of WL interventions.
短期随访研究表明，减肥（WL）对心脏有有益影响，但关于长期效果或内脏脂肪减少的效果的信息有限。
本研究旨在评估减肥手术后长期 WL 对心脏结构、功能、心室相互作用和身体成分的影响，包括心外膜脂肪厚度和腹部内脏脂肪组织（VAT）。
共有 213 名肥胖患者在减肥手术前和术后 >180 天进行了超声心动图检查。其中 52 名患者通过计算机断层扫描测量了腹部 VAT 面积。
5.3 年后（IQR：2.9-7.9 年），体重指数（BMI）下降 22%，血压、空腹血糖和左心室（LV）重构均有改善。在有腹部计算机断层扫描的患者亚组中，VAT 面积减少了 30%。在所有受试者中，心外膜脂肪厚度减少了 14%（均 P<0.0001），同时心室相互依赖性降低。WL 后 LV 和右心室纵向应变改善，但左心房（LA）应变恶化，而 LA 容积和估计 LA 压力增加。在亚组分析中，LV 壁厚度和应变与基线时的 VAT 比 BMI 相关性更强，手术后 LV 质量的减少与 VAT 的减少相关，而与 BMI 无关。
在这项观察性研究中，减肥手术后的体重减轻与心外膜脂肪减少、心室相互作用减少、LV 逆向重构以及改善的纵向双心室力学相关，但 LA 心肌病和血液动力学充血仍在进展。内脏脂肪的减少与心脏有益效果相关，提示这可能是 WL 干预的关键目标。
