Grymyr Lisa M D, Nadirpour Saied, Gerdts Eva, Nedrebø Bjørn G, Matre Knut, Cramariuc Dana
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (L.M.D.G., D.C.).
Department of Clinical Science (L.M.D.G., K.M., D.C.), University of Bergen, Norway.
Circ Heart Fail. 2025 May;18(5):e012367. doi: 10.1161/CIRCHEARTFAILURE.124.012367. Epub 2025 Apr 7.
The long-term impact of bariatric surgery on cardiac mechanics and energetics has been scarcely documented. We aimed to assess prospectively the 5-year trajectories of left heart geometry, mechanics, and myocardial oxygen (O) demand after bariatric surgery.
In the Bariatric Surgery on the West Coast of Norway study, left ventricular (LV) and atrial remodeling was evaluated preoperatively, 6 months, and 1 and 5 years after Roux-en-Y gastric bypass in 102 patients. LV geometry was assessed by the LV mass/height and the relative wall thickness, and mechanics by the global longitudinal strain and the midwall shortening. LV myocardial O demand was estimated from the product LV mass×wall stress×heart rate. The left atrial reservoir function was measured by the emptying fraction.
After 63 (interquartile range, 62-66) months, LV mass index, global longitudinal strain, myocardial oxygen demand, and left atrial emptying fraction were improved (<0.001) while midwall shortening did not change significantly. Prevalence of normal LV geometry increased from 61% to 82%. In linear mixed-effects models with adjustment for clinical characteristics, improving global longitudinal strain and myocardial O demand over time were associated with female sex and lower body mass index (<0.05). In logistic regression analysis, 5-year presence of abnormal LV geometry, low LV global longitudinal strain, or high myocardial O demand was related to preoperative diabetes, hypertension, and higher body mass index, as well as higher 5-year systolic blood pressure (<0.05; Nagelkerke R=0.40).
Bariatric surgery results in favorable 5-year trajectories of LV geometry, myocardial O demand, and left heart longitudinal mechanics. However, suboptimal postoperative body mass index and blood pressure control promote long-term LV structural disease.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01533142.
减肥手术对心脏力学和能量代谢的长期影响鲜有文献记载。我们旨在前瞻性评估减肥手术后左心几何结构、力学和心肌氧需求的5年变化轨迹。
在挪威西海岸减肥手术研究中，对102例接受Roux-en-Y胃旁路手术的患者在术前、术后6个月、1年和5年进行左心室（LV）和心房重塑评估。通过左心室质量/身高和相对壁厚评估左心室几何结构，通过整体纵向应变和中壁缩短评估力学。根据左心室质量×壁应力×心率乘积估算左心室心肌氧需求。通过排空分数测量左心房储备功能。
63（四分位间距，62 - 66）个月后，左心室质量指数、整体纵向应变、心肌氧需求和左心房排空分数得到改善（<0.001），而中壁缩短无显著变化。正常左心室几何结构的患病率从61%增至82%。在调整临床特征的线性混合效应模型中，随着时间推移整体纵向应变和心肌氧需求的改善与女性性别和较低体重指数相关（<0.05）。在逻辑回归分析中，5年时左心室几何结构异常、左心室整体纵向应变低或心肌氧需求高与术前糖尿病、高血压、较高体重指数以及较高的5年收缩压相关（<0.05；Nagelkerke R = 0.40）。
减肥手术可使左心室几何结构、心肌氧需求和左心纵向力学在5年内呈现良好变化轨迹。然而，术后体重指数和血压控制欠佳会促进左心室长期结构病变。
