Left ventricular myocardial oxygen demand and subclinical dysfunction in patients with severe obesity referred for bariatric surgery

Grymyr, Lisa M; Nadirpour, Saied; Gerdts, Eva; Nedrebø, Bjørn Gunnar; Hjertaas, Johannes Just; Matre, Knut; Cramariuc, Dana

doi:10.1016/j.numecd.2020.10.009

Cited by 8 publications

(13 citation statements)

References 39 publications

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“…Inclusion and exclusion criteria have been previously reported. 4 In the FatWest study patients are followed by clinical examination, echocardiography, and polysomnography preoperatively as well as 6 months, 1-, 2-, and 5-year postoperatively. The present analysis is based on the preoperative, and the first two follow-up visits planned 6 months and 1 year after surgery according to the study protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Early postoperative complications in the FatWest population have been previously published. 4 In the present report, we summarize the complications occurring after the perioperative period and up to 1 year after surgery.…”

Section: Methodsmentioning

confidence: 99%

“… 15 LV hypertrophy was identified as recommended in obesity as LV mass indexed for height 2 .7 ≥49.2 g/m 2.7 in men and ≥46.7 g/m 2.7 in women. 4 , 16 The ratio of LV end-diastolic posterior wall thickness/internal diameter (the relative wall thickness) indicated concentric LV geometry when equal to or above 0.43. 15 …”

Section: Methodsmentioning

confidence: 99%

“…Severe obesity has increased substantially and in a continuous manner during the past 20 years and is estimated to affect 177 million adults by 2025. 1 Its associations with high cardiovascular risk 2 , 3 and subclinical cardiac disease 4 have been well-documented. The ongoing coronavirus disease 2019 (COVID-19) pandemic has additionally demonstrated obesity as a risk factor for cardiac complications, more severe disease course, and increased COVID-19 mortality, particularly in younger patients.…”

Section: Introductionmentioning

confidence: 99%

“…In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study, we have previously documented a high preoperative prevalence of impaired LV mechanics in patients with severe obesity, in particular in those with high LV myocardial oxygen demand. 4 In the present analysis, we evaluate the amplitude and the determinants of changes in LV systolic function (assessed by the LV EF) and mechanics [by LV GLS and midwall shortening (MWS)] in the FatWest population during the first year after bariatric surgery.…”

Section: Introductionmentioning

confidence: 99%

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One-year impact of bariatric surgery on left ventricular mechanics: results from the prospective FatWest study

Grymyr

Nadirpour²,

Gerdts

et al. 2021

European Heart Journal Open

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Aims Patients with severe obesity are predisposed to left ventricular (LV) hypertrophy, increased myocardial oxygen demand, and impaired myocardial mechanics. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. The present prospective study assesses whether LV wall mechanics improve 1 year after bariatric surgery. Methods and results Ninety-four severely obese patients [43 ± 10 years, 71% women, body mass index (BMI) 41.8 ± 4.9 kg/m2, 57% with hypertension] underwent echocardiography before, 6 months and 1 year after gastric bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), LV power/mass as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, and myocardial oxygen demand as the LV mass-wall stress-heart rate product. Surgery induced a significant reduction in BMI, heart rate, and BP (P < 0.001). Prevalence of LV hypertrophy fell from 35% to 19% 1 year after surgery (P < 0.001). The absolute value of GLS improved by—4.6% (i.e. 29% increase in GLS) while LV ejection fraction, MWS, and LV power/mass remained unchanged. In multivariate regression analyses, 1 year improvement in GLS was predicted by lower preoperative GLS, larger mean BP, and BMI reduction (all P < 0.05). Low 1-year MWS was associated with female sex, preoperative hypertension, and higher 1-year LV relative wall thickness and myocardial oxygen demand (all P < 0.001). Conclusion In severely obese patients, LV longitudinal function is largely recovered one year after bariatric surgery due to reduced afterload. LV midwall mechanics does not improve, particularly in women and patients with persistent LV geometric abnormalities. ClinicalTrials.gov identifier NCT01533142, 15 February 2012.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%