Cardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy

Casella, Giovanni; Calì, Benedetto; Dammaro, Carmelisa; Biondi‐Zoccai, Giuseppe; Iossa, Angelo; Leonetti, Frida; Frati, Giacomo; Basso, Nicola

doi:10.1007/s00268-012-1874-8

Cited by 42 publications

(26 citation statements)

References 46 publications

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“…It has previously been shown that surgical induced weight loss has positive effects on cardiac function [31], [53], [54], [55], [56]. Syed reported a decrease of myocardial mass, but no significant improvement of functional parameters following a structured program combining diet, exercise and surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The benefit of surgically induced weight loss on lung and cardiac function has been convincingly demonstrated [13], [31]. In contrast, there are few studies that have assessed the effect of structured weight reduction programs on pulmonary function and echocardiographically measured cardiac function, blood pressure and pulmonary hemodynamics assessed by echocardiography or right heart catheterization and they have shown conflicting results [32]–[34].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

et al. 2014

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BackgroundThe prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear.ObjectiveTo determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters.MethodsWe prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program.Results74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = −0.42, p<0.001), FEV1 (R = −0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (−26.0±11.8 kg) and BMI (−8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5% pred., p<0.001; FEV1+9.8±8.3% pred., p<0.001, ITGV+16.4±16.0% pred., p<0.001, SR tot −17.4±41.5% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = −0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (−0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (−0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased.ConclusionEven in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

et al. 2014

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“…For patients with severe obesity, the most effective method of achieving significant and sustained weight reduction is by weight-reducing surgery (14). In addition, the weight loss after surgery also significantly correlates with improvements to blood pressure (22,23), left ventricular mass (24), exercise capacity (25), and glucose metabolism (26). Changes to weight in patients are associated with profound modulation of the cytokine and inflammatory profiles of adipose tissue.…”

Section: Discussionmentioning

confidence: 99%

Effects of Bariatric Surgery on Human Small Artery Function

Aghamohammadzadeh

Greenstein

Yadav

et al. 2013

Journal of the American College of Cardiology

149

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ObjectivesThe aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this.BackgroundIn lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress.MethodsSegments of small subcutaneous artery and perivascular fat were harvested from severely obese individuals before (n = 20) and 6 months after bariatric surgery (n = 15). Small artery contractile function was examined in vitro with wire myography, and perivascular adipose tissue (PVAT) morphology was assessed with immunohistochemistry.ResultsThe anticontractile activity of PVAT was lost in obese patients before surgery when compared with healthy volunteers and was restored 6 months after bariatric surgery. In vitro protocols with superoxide dismutase and catalase rescued PVAT anticontractile function in tissue from obese individuals before surgery. The improvement in anticontractile function after surgery was accompanied by improvements in insulin sensitivity, serum glycemic indexes, inflammatory cytokines, adipokine profile, and systolic blood pressure together with increased PVAT adiponectin and nitric oxide bioavailability and reduced macrophage infiltration and inflammation. These changes were observed despite the patients remaining severely obese.ConclusionsBariatric surgery and its attendant improvements in weight, blood pressure, inflammation, and metabolism collectively reverse the obesity-induced alteration to PVAT anticontractile function. This reversal is attributable to reductions in local adipose inflammation and oxidative stress with improved adiponectin and nitric oxide bioavailability.

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“…165 Interestingly, cardiac remodelling occurs after surgery, with echocardiographic studies showing decreased LV hypertrophy and improved function. 114,166 Specifically, sustained weight loss leads to smaller cavity size, wall thickness, and LV mass. 167 In severely obese patients with preserved LV systolic function (!…”

Section: Cardiac Functionmentioning

confidence: 99%