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Cardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy

World Journal of Surgery volume 37, pages 565–572 (2013)Cite this article

Abstract

Background

Obesity is associated with high morbidity and represents an increasing health care problem worldwide. Laparoscopic sleeve gastrectomy (LSG) has been used effectively for weight loss and co-morbidity remission. In this retrospective study, we evaluated cardiac reverse remodeling at medium-term follow-up by echocardiography, the amount of cardiovascular medications, and the impact of co-morbidities after sleeve gastrectomy.

Methods

Altogether, 16 obese patients (4 men, 12 women; 46.4 ± 10.3 years) underwent complete clinical evaluation, laboratory tests, and color Doppler/tissue Doppler imaging echocardiography preoperatively and 12–20 months after bariatric surgery.

Results

Body weight (mean body mass index) was significantly reduced (from 44.8 ± 8.0 to 31.2 ± 7.8 kg/m2; p = 0.001). Lipid profile significantly improved: total cholesterol and triglycerides decreased (respectively: 215.5 ± 53.8 vs. 205.3 ± 46.6 mg/dl and 184.9 ± 109.3 vs. 116.1 ± 49.9 mg/dl, both p ≤ 0.05), and high-density lipoprotein increased (43.1 ± 10.9 vs. 51.4 ± 12.8 mg/dl, p = 0.005). Systolic blood pressure significantly decreased (from 133.0 ± 17.1 to 120.6 ± 13.7 mmHg; p = 0.04). Diabetes remission was complete in five of six patients (83 %) and sleep apnea in four of five (80 %). Echocardiography showed significantly reduced interventricular septum and posterior wall thickness (11.3 ± 1.8 to 9.4 ± 2.1 mm and 10.4 ± 1.7 to 8.6 ± 1.9 mm, respectively; both p < 0.007) and reduced left ventricular mass (absolute value and indexed by height, respectively: 222.41 ± 78.2 to 172.75 ± 66.3 g (p = 0.003) and 55.9 ± 14.3 to 43.8 ± 17.2 g/m2.7 (p = 0.0004). Antihypertensive drug intake was significantly reduced (p = 0.03), as shown by the 10-year Framingham Risk Score (from 14.2 ± 9.3 to 8.3 ± 9.5 %, p = 0.003).

Conclusions

Sleeve gastrectomy is associated with marked improvement in terms of weight loss, lipid profile, type 2 diabetes, sleep apnea, hypertension, and left ventricular hypertrophy, with a significantly reduced Framingham Risk Score.

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References

  1. Guh DP, Zhang W, Bansback N et al (2009) The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9:88

    PubMed  Article  Google Scholar 

  2. Sjöström L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65

    PubMed  Article  Google Scholar 

  3. Pascual M, Pascual DA, Soria F et al (2003) Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 89:1152–1156

    PubMed  Article  CAS  Google Scholar 

  4. Wong CY, O’Moore-Sullivan T, Leano R et al (2004) Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 110:3081–3087

    PubMed  Article  Google Scholar 

  5. Alpert MA (2001) Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 321:225–236

    PubMed  Article  CAS  Google Scholar 

  6. Adams TD, Gress RE, Smith SC et al (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761

    PubMed  Article  CAS  Google Scholar 

  7. Buchwald H, Estok R, Fahrbach K et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256

    PubMed  Article  Google Scholar 

  8. Algahim MF, Lux TR, Leichman JG et al (2010) Progressive regression of left ventricular hypertrophy two years after bariatric surgery. Am J Med 123:549–555

    PubMed  Article  Google Scholar 

  9. Heneghan HM, Meron-Eldar S, Brethauer SA et al (2011) Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol 108:1499–1507

    PubMed  Article  Google Scholar 

  10. Gill RS, Birch DW, Shi X et al (2010) Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 6:707–713

    PubMed  Article  Google Scholar 

  11. Basso N, Casella G, Rizzello M et al (2011) Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc 25:444–449

    PubMed  Article  CAS  Google Scholar 

  12. Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery (2010) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 6:1–5

    Article  Google Scholar 

  13. Fleisher LA, Beckman JA, Brown KA et al (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 50:e159–e241

    PubMed  Article  Google Scholar 

  14. Wilson PW, D’Agostino RB, Levy D et al (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847

    PubMed  Article  CAS  Google Scholar 

  15. D’Agostino RB Sr, Vasan RS, Pencina MJ et al (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117:743–753

    PubMed  Article  Google Scholar 

  16. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    PubMed  Article  Google Scholar 

  17. Palmieri V, de Simone G, Arnett DK et al (2001) Relation of various degrees of body mass index in patients with systemic hypertension to left ventricular mass, cardiac output, and peripheral resistance (The Hypertension Genetic Epidemiology Network Study). Am J Cardiol 88:1163–1168

    PubMed  Article  CAS  Google Scholar 

  18. Finnucane MM, Stevens GA, Cowan MJ et al (2011) Global Burden of Metabolic Risk Factors of Chronic Disease Collaborating Group (Body Mass Index): national, regional, and global trends in body-mass index since 1980—systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377:557–567

    Article  Google Scholar 

  19. Clarke R (2011) Long-term weight loss and prevention of cardiovascular disease. Circulation 124:2801–2802

    PubMed  Article  Google Scholar 

  20. Deitel M, Gagner M, Erickson AL et al (2011) Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis 7:749–759

    PubMed  Article  Google Scholar 

  21. Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery (2007) Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 3:573–576

    Article  Google Scholar 

  22. Anonymous (2011) Updated position statement on sleeve gastrectomy as a bariatric procedure. http://asmbs.org/guidelines-statements/. Accessed 28 Oct 2011

  23. Himeno E, Nishino K, Nakashima Y et al (1996) Weight reduction regresses left ventricular mass regardless of blood pressure level in obese subjects. Am Heart J 131:313–319

    PubMed  Article  CAS  Google Scholar 

  24. Kardassis D, Bech-Hanssen O, Schönander M et al (2012) The influence of body composition, fat distribution and sustained weight loss on left ventricular mass and geometry in obesity. Obesity 20:605–611

    PubMed  Article  Google Scholar 

  25. De Castro S, Caselli S, Maron M et al (2007) Left ventricular remodelling index (LVRI) in various pathophysiological conditions: a real-time three-dimensional echocardiographic study. Heart 93:205–209

    PubMed  Article  Google Scholar 

  26. Hsuan CF, Huang CK, Lin JW et al (2010) The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity 18:1188–1193

    PubMed  Article  Google Scholar 

  27. Syed M, Torosoff M, Rosati C et al (2010) Effect of comorbidities and medications on left ventricular mass regression after bariatric surgery. J Clin Hypertens 12:223–227

    Article  Google Scholar 

  28. Abbatini F, Rizzello M, Casella G et al (2010) Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc 24:1005–1010

    PubMed  Article  CAS  Google Scholar 

  29. Vidal J, Ibarzabal A, Romero F et al (2008) Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg 18:1077–1082

    PubMed  Article  CAS  Google Scholar 

  30. Basso N, Capoccia D, Rizzello M et al (2011) First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis. Surg Endosc 25:3540–3550

    PubMed  Article  CAS  Google Scholar 

  31. Rizzello M, Abbatini F, Casella G et al (2010) Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg 20:50–55

    PubMed  Article  Google Scholar 

  32. Leonetti F, Capoccia D, Coccia F et al (2012) Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment. Arch Surg 147:694–700

    PubMed  Article  CAS  Google Scholar 

  33. Zhang F, Strain GW, Lei W et al (2011) Changes in lipid profiles in morbidly obese patients after laparoscopic sleeve gastrectomy (LSG). Obes Surg 21:305–309

    PubMed  Article  Google Scholar 

  34. Benaiges D, Flores-Le-Roux JA, Pedro-Botet J et al (2012) Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (roux-en-Y gastric bypass) on lipid profile. Obes Surg 22:1268–1275

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

This study was supported by Sapienza University of Rome Research Grant and grants from Fondazione Roma. We are grateful to Dr. Isotta Chimenti for her critical reading.

Conflict of interest

The authors declare no conflict of interest.

Author information

Affiliations

  1. Surgical-Medical Department for Digestive Diseases, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Giovanni Casella, Benedetto Calì, Carmelisa Dammaro, Angelo Iossa & Nicola Basso

  2. Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Corso Della Repubblica 79, 04100, Latina, Italy

    Elena Cavarretta, Giuseppe Biondi-Zoccai & Giacomo Frati

  3. Department of Clinical Sciences, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Frida Leonetti

  4. Department of Angiocardioneurology, IRCCS Neuromed, 86077, Pozzilli, Isernia, Italy

    Giacomo Frati

Authors
  1. Elena Cavarretta
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  2. Giovanni Casella
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  3. Benedetto Calì
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  4. Carmelisa Dammaro
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  5. Giuseppe Biondi-Zoccai
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  6. Angelo Iossa
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  7. Frida Leonetti
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  8. Giacomo Frati
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  9. Nicola Basso
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Corresponding author

Correspondence to Nicola Basso.

Additional information

Elena Cavarretta and Giovanni Casella contributed equally to this work.

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Cavarretta, E., Casella, G., Calì, B. et al. Cardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy. World J Surg 37, 565–572 (2013). https://doi.org/10.1007/s00268-012-1874-8

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  • DOI: https://doi.org/10.1007/s00268-012-1874-8

Keywords

  • Sleeve Gastrectomy
  • Left Atrium
  • Obstructive Sleep Apnea Syndrome
  • Laparoscopic Sleeve Gastrectomy
  • Leave Ventricular Mass