Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
Obes Surg. 2023 Jan;33(1):47-56. doi: 10.1007/s11695-022-06336-x. Epub 2022 Nov 5.
Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery.
Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35-65 years and BMI ≥ 35 kg/m. Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I.
A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery.
Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction.
亚临床心脏功能障碍在肥胖患者中很常见。减重手术可使 50%的肥胖患者的亚临床心脏功能正常化。本研究旨在确定减重手术后亚临床心脏功能障碍无改善的预测因素。
接受减重手术的患者被纳入一项纵向研究。纳入标准为年龄 35-65 岁，BMI≥35kg/m。排除有心血管疾病怀疑或已知心血管疾病的患者。术前和术后 1 年均进行常规和高级超声心动图、动态心电图监测和血液检查。亚临床心脏功能障碍定义为左心室射血分数降低、整体纵向应变（GLS）降低、舒张功能障碍、心律失常或 BNP 或 hs 肌钙蛋白 I 升高。
共纳入 99 例患者，其中 59 例患者基线时存在心脏功能障碍。72 例患者完成了减重手术后 1 年的随访。体重和心血管危险因素显著降低。心脏功能参数如 GLS 改善。然而，20 例患者的心脏功能障碍仍然存在。多变量分析确定术前心率变异性（自主功能的一种测量）降低和维生素 D 降低是减重手术后亚临床心脏功能障碍的预测因素。
尽管减重手术后 1 年心脏功能总体改善，但自主神经功能障碍和术前维生素 D 降低是亚临床心脏功能障碍无改善的预测因素。
