采用自动定量灌注 CMR 评估肥胖症手术对冠状动脉微血管功能的影响。

The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR.

机构信息

School of Life Course Sciences, King's College London, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom.

Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom. Electronic address: https://twitter.com/drgeorgejoy.

出版信息

JACC Cardiovasc Imaging. 2024 Nov;17(11):1305-1316. doi: 10.1016/j.jcmg.2024.05.022. Epub 2024 Aug 7.

DOI:10.1016/j.jcmg.2024.05.022

PMID:39115498

Abstract

BACKGROUND

Coronary microvascular function is impaired in patients with obesity, contributing to myocardial dysfunction and heart failure. Bariatric surgery decreases cardiovascular mortality and heart failure, but the mechanisms are unclear.

OBJECTIVES

The authors studied the impact of bariatric surgery on coronary microvascular function in patients with obesity and its relationship with metabolic syndrome.

METHODS

Fully automated quantitative perfusion cardiac magnetic resonance and metabolic markers were performed before and 6 months after bariatric surgery.

RESULTS

Compared with age- and sex-matched healthy volunteers, 38 patients living with obesity had lower stress myocardial blood flow (MBF) (P = 0.001) and lower myocardial perfusion reserve (P < 0.001). A total of 27 participants underwent paired follow-up 6 months post-surgery. Metabolic abnormalities reduced significantly at follow-up including mean body mass index by 11 ± 3 kg/m (P < 0.001), glycated hemoglobin by 9 mmol/mol (Q1-Q3: 4-19 mmol/mol; P < 0.001), fasting insulin by 142 ± 131 pmol/L (P < 0.001), and hepatic fat fraction by 5.6% (Q1-Q3: 2.6%-15.0%; P < 0.001). Stress MBF increased by 0.28 mL/g/min (Q1-Q3: -0.02 to 0.75 mL/g/min; P = 0.003) and myocardial perfusion reserve by 0.13 (Q1-Q3: -0.25 to 1.10; P = 0.036). The increase in stress MBF was lower in those with preoperative type 2 diabetes mellitus (0.1 mL/g/min [Q1-Q3: -0.09 to 0.46 mL/g/min] vs 0.75 mL/g/min [Q1-Q3: 0.31-1.25 mL/g/min]; P = 0.002). Improvement in stress MBF was associated with reduction in fasting insulin (beta = -0.45 [95% CI: -0.05 to 0.90]; P = 0.03).

CONCLUSIONS

Coronary microvascular function is impaired in patients with obesity, but can be improved significantly with bariatric surgery. Improvements in microvascular function are associated with improvements in insulin resistance but are attenuated in those with preoperative type 2 diabetes mellitus.

摘要

背景

肥胖患者的冠状动脉微血管功能受损，导致心肌功能障碍和心力衰竭。减重手术可降低心血管死亡率和心力衰竭，但具体机制尚不清楚。

目的

作者研究了减重手术对肥胖患者冠状动脉微血管功能的影响及其与代谢综合征的关系。

方法

对 38 名肥胖患者进行了全自动定量灌注心脏磁共振和代谢标志物检测，并在减重手术前和 6 个月后进行了检测。

结果

与年龄和性别匹配的健康志愿者相比，38 名肥胖患者的应激性心肌血流（MBF）更低（P = 0.001），心肌灌注储备更低（P < 0.001）。共有 27 名参与者接受了术后 6 个月的配对随访。随访时代谢异常显著改善，包括平均体重指数降低 11 ± 3 kg/m²（P < 0.001），糖化血红蛋白降低 9 mmol/mol（Q1-Q3：4-19 mmol/mol；P < 0.001），空腹胰岛素降低 142 ± 131 pmol/L（P < 0.001），肝脂肪分数降低 5.6%（Q1-Q3：2.6%-15.0%；P < 0.001）。应激 MBF 增加 0.28 mL/g/min（Q1-Q3：-0.02 至 0.75 mL/g/min；P = 0.003），心肌灌注储备增加 0.13（Q1-Q3：-0.25 至 1.10；P = 0.036）。术前患有 2 型糖尿病的患者应激 MBF 增加幅度较低（0.1 mL/g/min [Q1-Q3：-0.09 至 0.46 mL/g/min] vs 0.75 mL/g/min [Q1-Q3：0.31-1.25 mL/g/min]；P = 0.002）。应激 MBF 的改善与空腹胰岛素的降低相关（β=-0.45[95%CI：-0.05 至 0.90]；P = 0.03）。