General Surgery, Lady Hardinge Medical College, New Delhi, India.
Lady Hardinge Medical College, Room No 404, New Academic Block, 110001, New Delhi, India.
Surg Endosc. 2024 May;38(5):2879-2886. doi: 10.1007/s00464-024-10779-x. Epub 2024 Mar 22.
We aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on carotid intima-media thickness (CIMT) & left ventricular dysfunction (LVD) which are the independent predictors of subclinical atherosclerosis.
To assess the change in CIMT & echocardiographic parameters of left ventricular function & correlate with %EWL 6 months and 12 months after LSG, the mean CIMT of bilateral common carotid arteries were measured at 3 different places & 7 parameters were assessed for left ventricular dysfunction after 6 and 12 months of LSG & correlated with the %EWL.
A total of 30 patients (27(90%) women & 3(10%) men) with the mean age of 38 ± 7.84 were prospectively enrolled. BMI was significantly reduced from 42.66 ± 3.79 to 37.93 ± 3.60 kg/m at six months to 36 ± 3.34 at 12 months after LSG. CIMT values were significantly decreased at 6 months after surgery from 0.50 ± 0.11 mm to 0.46 ± 0.09 mm (p < 0.01) to 0.39 ± 0.07 (p < 0.05) at 12 months. However, no significant change was observed in the right mean CCA values at 6 months after surgery 0.50 ± 0.11 mm vs 0.47 ± 0.09 mm (p = 0.07) as compared to decrease at 12 months after surgery to 0.40 ± 0.08 (p < 0.05). Left mean CCA values at 6 months changed from 0.50 ± 0.11 to 0.45 ± 0.09 (p < 0.01) and at 12 months after surgery to 0.39 ± 007(p < 0.05). On 2D ECHO, ejection fraction increased at 6 months from 60.80 ± 5.89 to 61.93 ± 4.47 (p < 0.5) to after 12 months at 64.30 ± 4.20 (p < 0.05). Wave deceleration time changed at 6 months from 170 ± 36.80 to 150 ± 28.82 (p < 0.05) to 12 months 139.07 ± 17.98 (p < 0.05). Peak early diastolic mitral annular velocity (e) changed at 6 months from 8.12 ± 1.66 to 7.02 ± 1.76 (p < 0.05) to 12 months 6.33 ± 0.76 (p < 0.05). Inter-ventricular septum thickness (IVSD) changed at 6 months from 0.99 ± 0.14 to 0.91 ± 0.14 (p < 0.05) to 12 months 0.82 ± 0.09 (p < 0.05). Intraventricular relaxation time (IVRT) at 6 months changed from 94.33 ± 21.71 to 84.36 ± 14.85 (p < 0.03) to 12 months after surgery 77.40 ± 10.19 (p < 0.05). Left atrial volume index (LAVI) at 6 months decreased from 38.08 ± 11.23 to 30.93 ± 7.16 (p < 0.01) to 12 months after surgery 25.43 ± 3.65 (p < 0.05). Left ventricular diastolic dysfunction [LVIDD] at 6 months changed from 4.32 ± 0.52 to 4.11 ± 0.52 (p < 0.02) to 3.94 ± 0.26 (p < 0.05) to 3.94 ± 0.26 (p < 0.05) at 12 months after surgery. PwD at 6 and 12 months changed from 1.00 ± 0.19 to 0.87 ± 0.10 (p < 0.01) to 0.82 ± 0.08 (p < 0.05) respectively. LV mass changed in 6 months from 148.37 ± 33.09 to 117 ± 29.90 (p < 0.001) to 12 months at 110.64 ± 20.79 (p < 0.05) and left ventricular mass index [LVMI] changed in 6 months from 70 ± 16.89 to 59.626 ± 15.35 (p < 0.001) reaching a value of 57.53 ± 11.18 (p < 0.05) at 12 months. The mean 10-year risk of death due to CVD calculated was significantly reduced from 5.45 ± 6.6 to 2.8 ± 1.7% at 6 months (p < 0.05). This significant decrease in CVD risk has a positive correlation with the decrease in CIMT over 6 months showing a correlation coefficient of 0.018 with statistically significant analysis (p value < 0.05).
We observed a significant reduction in CIMT & improvement in 2D ECHO parameters at 6 after LSG although no statistically significant change was observed in mean right CIMT & EF at 6 months.
我们旨在研究腹腔镜袖状胃切除术（LSG）对颈动脉内膜中层厚度（CIMT）和左心室功能障碍（LVD）的影响，这两者都是亚临床动脉粥样硬化的独立预测因子。
为了评估 CIMT 和左心室功能的超声心动图参数变化，并与 LSG 后 6 个月和 12 个月的 %EWL 相关，我们在双侧颈总动脉的 3 个不同部位测量了平均 CIMT，并在 LSG 后 6 个月和 12 个月评估了 7 个左心室功能参数，并与 %EWL 相关。
共纳入 30 名（27 名女性[90%]和 3 名男性[10%]）平均年龄为 38±7.84 岁的患者。BMI 从 LSG 前的 42.66±3.79kg/m 显著降低至术后 6 个月的 37.93±3.60kg/m，12 个月时降低至 36±3.34kg/m。手术后 6 个月 CIMT 值从 0.50±0.11mm 显著降低至 0.46±0.09mm（p<0.01），至 12 个月时降低至 0.39±0.07mm（p<0.05）。然而，与 12 个月时相比，手术后 6 个月右侧颈总动脉平均 CCA 值没有明显变化（0.50±0.11mm vs 0.47±0.09mm，p=0.07）。手术后 6 个月左颈总动脉平均 CCA 值从 0.50±0.11mm 降低至 0.45±0.09mm（p<0.01），12 个月时降低至 0.39±007mm（p<0.05）。二维超声心动图（2D ECHO）显示，术后 6 个月射血分数从 60.80±5.89 增加至 61.93±4.47（p<0.5），至 12 个月时增加至 64.30±4.20（p<0.05）。波减速时间从 170±36.80 缩短至 150±28.82（p<0.05），至 12 个月时缩短至 139.07±17.98（p<0.05）。舒张早期二尖瓣环速度（e）从 8.12±1.66 增加至 7.02±1.76（p<0.05），至 12 个月时增加至 6.33±0.76（p<0.05）。室间隔厚度（IVSD）从 0.99±0.14 减少至 0.91±0.14（p<0.05），至 12 个月时减少至 0.82±0.09（p<0.05）。IVRT 从 94.33±21.71 缩短至 84.36±14.85（p<0.03），至 12 个月时缩短至 77.40±10.19（p<0.05）。左心房容积指数（LAVI）从 38.08±11.23 减少至 30.93±7.16（p<0.01），至 12 个月时减少至 25.43±3.65（p<0.05）。左心室舒张功能障碍（LVIDD）从 4.32±0.52 减少至 4.11±0.52（p<0.02），至 3.94±0.26（p<0.05），至 3.94±0.26（p<0.05）。手术后 6 个月和 12 个月时，PwD 从 1.00±0.19 减少至 0.87±0.10（p<0.01），至 0.82±0.08（p<0.05）。LV 质量在 6 个月时从 148.37±33.09 减少至 117±29.90（p<0.001），至 12 个月时减少至 110.64±20.79（p<0.05），左心室质量指数（LVMI）在 6 个月时从 70±16.89 减少至 59.626±15.35（p<0.001），至 12 个月时减少至 57.53±11.18（p<0.05）。计算得出，由于 CVD 导致的 10 年内死亡风险显著降低，从 5.45±6.6 降低至 2.8±1.7%（p<0.05）。这种 CVD 风险的显著降低与 6 个月时 CIMT 的降低呈正相关，相关系数为 0.018，具有统计学显著意义（p 值<0.05）。
我们观察到 LSG 后 CIMT 显著降低，二维超声心动图参数改善，尽管 6 个月时右侧颈总动脉平均 CIMT 和 EF 没有统计学意义上的显著变化。
