Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.
Bariatric and Metabolic Institute, Department of General Surgery Cleveland Clinic Cleveland OH.
J Am Heart Assoc. 2024 Jan 2;13(1):e031505. doi: 10.1161/JAHA.123.031505. Epub 2023 Dec 29.
Obesity leads to an increased risk of cardiovascular disease morbidity and death, including heart failure. Bariatric surgery has been proven to be the most effective long-term weight management treatment. This study investigated the changes in cardiac structure and function after bariatric surgery, including left ventricular global longitudinal strain.
There were 398 consecutive patients who underwent bariatric surgery with pre- and postoperative transthoracic echocardiographic imaging at a US health system between 2004 and 2019. We compared cardiovascular risk factors and echocardiographic parameters between baseline and follow-up at least 6 months postoperatively. Along with decreases in weight postoperatively, there were significant improvements in cardiovascular risk factors, including reduction in systolic blood pressure levels from 132 mm Hg (25th-75th percentile: 120-148 mm Hg) to 127 mm Hg (115-140 mm Hg; =0.003), glycated hemoglobin levels from 6.5% (5.9%-7.6%) to 5.7% (5.4%-6.3%; <0.001), and low-density lipoprotein levels from 97 mg/dL (74-121 mg/dL) to 86 mg/dL (63-106 mg/dL; <0.001). Left ventricular mass decreased from 205 g (165-261 g) to 190 g (151-236 g; <0.001), left ventricular ejection fraction increased from 58% (55%-61%) to 60% (55%-64%; <0.001), and left ventricular global longitudinal strain improved from -15.7% (-14.3% to -17.5%) to -18.6% (-16.0% to -20.3%; <0.001) postoperatively.
This study has shown the long-term impact of bariatric surgery on cardiac structure and function, with reductions in left ventricular mass and improvement in left ventricular global longitudinal strain. These findings support the cardiovascular benefits of bariatric surgery.
肥胖会增加心血管疾病发病率和死亡率，包括心力衰竭。减重手术已被证明是最有效的长期体重管理治疗方法。本研究调查了减重手术后心脏结构和功能的变化，包括左心室整体纵向应变。
在美国医疗系统中，2004 年至 2019 年间，有 398 例连续患者接受了减重手术，并在术前和术后进行了经胸超声心动图检查。我们比较了基线和术后至少 6 个月的心血管危险因素和超声心动图参数。随着术后体重的下降，心血管危险因素显著改善，包括收缩压水平从 132mmHg（25-75 百分位：120-148mmHg）降至 127mmHg（115-140mmHg；=0.003），糖化血红蛋白水平从 6.5%（5.9%-7.6%）降至 5.7%（5.4%-6.3%；<0.001），低密度脂蛋白水平从 97mg/dL（74-121mg/dL）降至 86mg/dL（63-106mg/dL；<0.001）。左心室质量从 205g（165-261g）降至 190g（151-236g；<0.001），左心室射血分数从 58%（55%-61%）增加到 60%（55%-64%；<0.001），左心室整体纵向应变从-15.7%（-14.3%至-17.5%）增加到-18.6%（-16.0%至-20.3%；<0.001）。
本研究表明了减重手术对心脏结构和功能的长期影响，左心室质量减少，左心室整体纵向应变改善。这些发现支持减重手术的心血管益处。
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