Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

Dennis de Witte, Leontine H Wijngaarden, Vera A A van Houten, Marinus A van den Dorpel, Tobias A Bruning, Erwin van der Harst, René A Klaassen, Roelf A Niezen, Dennis de Witte, Leontine H Wijngaarden, Vera A A van Houten, Marinus A van den Dorpel, Tobias A Bruning, Erwin van der Harst, René A Klaassen, Roelf A Niezen

Abstract

Purpose: Metabolic syndrome in patients with morbid obesity causes a higher cardiovascular morbidity, eventually leading to left ventricular hypertrophy and decreased left ventricular ejection fraction (LVEF). Roux-en-Y gastric bypass (RYGB) is considered the gold standard modality for treatment of morbid obesity and might even lead to improved cardiac function. Our objective is to investigate whether cardiac function in patients with morbid obesity improves after RYGB.

Materials and methods: In this single center pilot study, 15 patients with an uneventful cardiac history who underwent RYGB were included from May 2015 to March 2016. Cardiac function was measured by cardiac magnetic resonance imaging (CMRI), performed preoperatively and 3, 6, and 12 months postoperative. LVEF and myocardial mass and cardiac output were measured.

Results: A total of 13 patients without decreased LVEF preoperative completed follow-up (mean age 37, 48.0 ± 8.8). There was a significant decrease of cardiac output 12 months postoperative (8.3 ± 1.8 preoperative vs. 6.8 ± 1.8 after 12 months, P = 0.001). Average myocardial mass declined by 15.2% (P < 0.001). After correction for body surface area (BSA), this appeared to be non-significant (P = 0.36). There was a significant improvement of LVEF/BSA at 6 and 12 months postoperative (26.2 ± 4.1 preoperative vs. 28.4 ± 3.4 and 29.2 ± 3.6 respectively, both P = 0.002). Additionally, there was a significant improvement of stroke volume/BSA 12 months after surgery (45.8 ± 8.0 vs. 51.9 ± 10.7, P = 0.033).

Conclusion: RYGB in patients with morbid obesity with uneventful history of cardiac disease leads to improvement of cardiac function.

Keywords: Bariatric surgery; Cardiac magnetic resonance imaging; Left ventricular ejection fraction; Left ventricular mass; Obesity; Roux-en-Y gastric bypass.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Changes in left ventricular ejection fraction / body surface area ratio. LVEF, left ventricular ejection fraction; BSA, body surface area

References

    1. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. Jama. 1999;282(16):1523–1529. doi: 10.1001/jama.282.16.1523.
    1. Jhaveri RR, Pond KK, Hauser TH, Kissinger KV, Goepfert L, Schneider B, et al. Cardiac remodeling after substantial weight loss: a prospective cardiac magnetic resonance study after bariatric surgery. Surg Obes Relat Dis. 2009;5(6):648–652. doi: 10.1016/j.soard.2009.01.011.
    1. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y Gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016;26(2):429–442. doi: 10.1007/s11695-015-1996-9.
    1. McCloskey CA, Ramani GV, Mathier MA, Schauer PR, Eid GM, Mattar SG, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007;3(5):503–507. doi: 10.1016/j.soard.2007.05.006.
    1. Ristow B, Rabkin J, Haeusslein E. Improvement in dilated cardiomyopathy after bariatric surgery. J Card Fail. 2008;14(3):198–202. doi: 10.1016/j.cardfail.2007.12.006.
    1. Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. The effects of bariatric surgery on cardiac structure and function: a systematic review of cardiac imaging outcomes. Obes Surg. 2016;26(5):1030–1040. doi: 10.1007/s11695-015-1866-5.
    1. Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J. 2005;26(15):1461–1474. doi: 10.1093/eurheartj/ehi258.
    1. Cuspidi C, Rescaldani M, Tadic M, Sala C, Grassi G. Effects of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Am J Hypertens. 2014;27(2):146–156. doi: 10.1093/ajh/hpt215.
    1. Michalsky MP, Raman SV, Teich S, Schuster DP, Bauer JA. Cardiovascular recovery following bariatric surgery in extremely obese adolescents: preliminary results using Cardiac Magnetic Resonance (CMR) Imaging. J Pediatr Surg. 2013;48(1):170–177. doi: 10.1016/j.jpedsurg.2012.10.032.
    1. Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, et al. [Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging]. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomografie und Magnetresonanztomografie. Rofo. 2012;184(4):345–368. doi: 10.1055/s-0031-1299400.
    1. Hergan K, Globits S, Schuchlenz H, Kaiser B, Fiegl N, Artmann A, et al. [Clinical relevance and indications for cardiac magnetic resonance imaging 2013: an interdisciplinary expert statement] Klinischer Stellenwert und Indikationen zur Magnetresonanztomografie des Herzens 2013: Ein interdisziplinares Expertenstatement. Rofo. 2013;185(3):209–218. doi: 10.1055/s-0032-1330763.
    1. Luijnenburg SE, Robbers-Visser D, Moelker A, Vliegen HW, Mulder BJ, Helbing WA. Intra-observer and interobserver variability of biventricular function, volumes and mass in patients with congenital heart disease measured by CMR imaging. Int J Card Imaging. 2010;26(1):57–64. doi: 10.1007/s10554-009-9501-y.
    1. Legget ME, Leotta DF, Bolson EL, McDonald JA, Martin RW, Li XN, et al. System for quantitative three-dimensional echocardiography of the left ventricle based on a magnetic-field position and orientation sensing system. IEEE Trans Biomed Eng. 1998;45(4):494–504. doi: 10.1109/10.664205.
    1. Kokkinos A, Alexiadou K, Liaskos C, Argyrakopoulou G, Balla I, Tentolouris N, et al. Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg. 2013;23(1):31–38. doi: 10.1007/s11695-012-0743-8.
    1. Garza CA, Pellikka PA, Somers VK, Sarr MG, Collazo-Clavell ML, Korenfeld Y, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105(4):550–556. doi: 10.1016/j.amjcard.2009.09.057.
    1. Graziani F, Leone AM, Cialdella P, Basile E, Pennestri F, Della Bona R, et al. Effects of bariatric surgery on cardiac remodeling: clinical and pathophysiologic implications. Int J Cardiol. 2013;168(4):4277–4279. doi: 10.1016/j.ijcard.2013.04.202.
    1. Du Bois DDB, E.F. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916;17(6):863–871. doi: 10.1001/archinte.1916.00080130010002.
    1. Owan T, Avelar E, Morley K, Jiji R, Hall N, Krezowski J, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57(6):732–739. doi: 10.1016/j.jacc.2010.10.017.
    1. Damiano S, De Marco M, Del Genio F, Contaldo F, Gerdts E, de Simone G, et al. Effect of bariatric surgery on left ventricular geometry and function in severe obesity. Obes Res Clin Pract. 2012;6(3):e175–e262. doi: 10.1016/j.orcp.2012.02.008.
    1. Brownell NK, Rodriguez-Flores M, Garcia-Garcia E, Ordonez-Ortega S, Oseguera-Moguel J, Aguilar-Salinas CA, et al. Impact of body mass index >50 on cardiac structural and functional characteristics and surgical outcomes after bariatric surgery. Obes Surg. 2016;26(11):2772–2778. doi: 10.1007/s11695-016-2199-8.
    1. Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51(14):1342–1348. doi: 10.1016/j.jacc.2007.12.029.
    1. Cunha Lde C, da Cunha CL, de Souza AM, Chiminacio Neto N, Pereira RS, Suplicy HL. Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery. Arq Bras Cardiol. 2006;87(5):615–622. doi: 10.1590/S0066-782X2006001800011.
    1. Hafidi ME, Buelna-Chontal M, Sanchez-Munoz F, et al. Adipogenesis: a necessary but harmful strategy. Int J Mol Sci. 2019;20(15)
    1. Goldberg IJ, Reue K, Abumrad NA, Bickel PE, Cohen S, Fisher EA, et al. Deciphering the role of lipid droplets in cardiovascular disease: a report from the 2017 National Heart, Lung, and Blood Institute Workshop. Circulation. 2018;138(3):305–315. doi: 10.1161/CIRCULATIONAHA.118.033704.
    1. Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis. 2018;61(2):142–150. doi: 10.1016/j.pcad.2018.07.003.
    1. Evangelista I, Nuti R, Picchioni T, et al. Molecular dysfunction and phenotypic derangement in diabetic cardiomyopathy. Int J Mol Sci. 2019;20(13)
    1. Alpert MA, Karthikeyan K, Abdullah O, Ghadban R. Obesity and cardiac remodeling in adults: mechanisms and clinical implications. Prog Cardiovasc Dis. 2018;61(2):114–123. doi: 10.1016/j.pcad.2018.07.012.
    1. Rider OJ, Francis JM, Ali MK, Petersen SE, Robinson M, Robson MD, et al. Beneficial cardiovascular effects of bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54(8):718–726. doi: 10.1016/j.jacc.2009.02.086.
    1. Kaier TE, Morgan D, Grapsa J, Demir OM, Paschou SA, Sundar S, et al. Ventricular remodelling post-bariatric surgery: is the type of surgery relevant? A prospective study with 3D speckle tracking. Eur Heart J Cardiovasc Imaging. 2014;15(11):1256–1262. doi: 10.1093/ehjci/jeu116.
    1. Verbraecken J, Van de Heyning P, De Backer W, Van Gaal L. Body surface area in normal- weight, overweight, and obese adults. A comparison study. Metabolism. 2006;55(4):515–524. doi: 10.1016/j.metabol.2005.11.004.
    1. Krovetz L. The physiologic significance of body surface area. J Pediatr. 1965;67(5):841–862. doi: 10.1016/S0022-3476(65)80376-6.
    1. Chiu CY, Pease D, Fawkner S, Sanders RH. Automated body volume acquisitions from 3D structured-light scanning. Comput Biol Med. 2018;101(2018):112–119. doi: 10.1016/j.compbiomed.2018.07.016.
    1. Verna EC, Berk PD. Role of fatty acids in the pathogenesis of obesity and fatty liver: impact of bariatric surgery. Semin Liver Dis. 2008;28(4):407–426. doi: 10.1055/s-0028-1091985.
    1. Goday A, Benaiges D, Parri A, Ramon JM, Flores-Le Roux JA, Pedro Botet J, et al. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surg Obes Relat Dis. 2014;10(5):871–876. doi: 10.1016/j.soard.2014.04.022.
    1. Pelascini E, Disse E, Pasquer A, Poncet G, Gouillat C, Robert M. Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals. Surg Obes Relat Dis. 2016;12(1):49–56. doi: 10.1016/j.soard.2015.04.024.
    1. Nguyen NT, Varela E, Sabio A, Tran CL, Stamos M, Wilson SE. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–29. doi: 10.1016/j.jamcollsurg.2006.03.019.
    1. Mikhalkova D, Holman SR, Jiang H, Saghir M, Novak E, Coggan AR, et al. Bariatric surgery-induced cardiac and lipidomic changes in obesity-related heart failure with preserved ejection fraction. Obesity (Silver Spring) 2018;26(2):284–290. doi: 10.1002/oby.22038.
    1. Priester T, Ault TG, Davidson L, Gress R, Adams TD, Hunt SC, et al. Coronary calcium scores 6 years after bariatric surgery. Obes Surg. 2015;25(1):90–96. doi: 10.1007/s11695-014-1327-6.
    1. Jonker FHW, van Houten VAA, Wijngaarden LH, Klaassen RA, de Smet A, Niezen A, et al. Age- related effects of bariatric surgery on early atherosclerosis and cardiovascular risk reduction. Obes Surg. 2018;28(4):1040–1046. doi: 10.1007/s11695-017-2962-5.

Source: PubMed

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