Tanahashi Yota, Sasaki Akira, Umemura Akira
Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan.
Obes Surg. 2025 Jul 5. doi: 10.1007/s11695-025-08000-6.
Patients with severe obesity exhibit a significant accumulation of epicardial adipose tissue (EAT) and mediastinal fat (MF). Although the accumulation of EAT has been reported to cause diastolic dysfunction owing to constrictive pericardial effects, the effect of MF on cardiac function remains unclear. The reduction of thoracic adipose tissue, including EAT and MF, may lead to improved cardiac function. The aim of the present study is to evaluate the effects of changes in EAT and MF on cardiac function after metabolic and bariatric surgery (MBS) on cardiac function.
We retrospectively evaluated the data of 75 patients who underwent laparoscopic sleeve gastrectomy (LSG) at a single institution. EAT and MF measurements and cardiac ultrasonography were performed at the initial visit and 1 year after LSG, and the relationships between changes in EAT and MF with cardiac function were investigated.
After LSG, EAT and MF significantly decreased (p < 0.001). Eight patients had diastolic dysfunction, and the improvement rate in diastolic dysfunction after LSG was 62.5%. Patients with diastolic dysfunction also had a greater accumulation of EAT than patients with normal diastolic function (74.6 vs. 102.2 mL, p = 0.041), along with a significantly greater rate of change in EAT after LSG (23.8% vs. 33.6%, p = 0.034). Univariate analysis results after propensity score (PS) matching also showed significantly greater EAT at the baseline in patients with diastolic dysfunction and indeterminate patients(69.8 vs. 102.2 mL, p = 0.034). Multivariate analysis results after PS matching showed that EAT accumulation at baseline may be an independent factor for diastolic dysfunction (odds ratio, 1.023; 95% confidence interval 1.000-1.054, p = 0.049), and the rate of change in EAT (odds ratio, 1.157; 95% confidence interval 1.029-1.435, p = 0.061) after MBS may also be independent factors.
In patients with severe obesity and diastolic dysfunction, EAT accumulation may exert significant pericardial constrictive effects. Furthermore, EAT significantly reduced after LSG, contributing to improved diastolic dysfunction.
重度肥胖患者的心外膜脂肪组织（EAT）和纵隔脂肪（MF）显著堆积。尽管已有报道称EAT堆积会因心包缩窄效应导致舒张功能障碍，但MF对心脏功能的影响仍不明确。减少包括EAT和MF在内的胸部脂肪组织可能会改善心脏功能。本研究旨在评估代谢和减重手术后（MBS）EAT和MF的变化对心脏功能的影响。
我们回顾性评估了在单一机构接受腹腔镜袖状胃切除术（LSG）的75例患者的数据。在初次就诊时以及LSG术后1年进行EAT和MF测量及心脏超声检查，并研究EAT和MF变化与心脏功能之间的关系。
LSG术后，EAT和MF显著减少（p < 0.001）。8例患者存在舒张功能障碍，LSG术后舒张功能障碍的改善率为62.5%。舒张功能障碍患者的心外膜脂肪堆积也比舒张功能正常的患者更多（74.6 vs. 102.2 mL，p = 0.041），并且LSG术后EAT的变化率也显著更高（23.8% vs. 33.6%，p = 0.034）。倾向评分（PS）匹配后的单因素分析结果也显示，舒张功能障碍患者和不确定患者在基线时的心外膜脂肪显著更多（69.8 vs. 102.2 mL，p = 0.034）。PS匹配后的多因素分析结果显示，基线时EAT堆积可能是舒张功能障碍的独立因素（比值比，1.023；95%置信区间1.000 - 1.054，p = 0.049），MBS后EAT的变化率（比值比，1.157；95%置信区间1.029 - 1.435，p = 0.061）也可能是独立因素。
在重度肥胖和舒张功能障碍患者中，EAT堆积可能产生显著的心包缩窄效应。此外，LSG术后EAT显著减少，有助于改善舒张功能障碍。
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