Key result
A preoperative risk index including female sex, hypertension, low ejection fraction, and high hsCRP predicted impaired left ventricular midwall shortening 1 year after bariatric surgery with an AUC of 0.80.
Why the study?
A large proportion of patients with severe obesity remain with LV dysfunction after bariatric surgery, prompting evaluation of whether preoperative echocardiography and inflammatory proteins can identify this high-risk group.
Does a preoperative risk index including inflammatory proteins predict persistent left ventricular dysfunction in patients with severe obesity undergoing bariatric surgery?
Cohort (n=75)
Yes
Does a preoperative risk index including inflammatory proteins predict persistent left ventricular dysfunction in patients with severe obesity undergoing bariatric surgery?
A preoperative risk index incorporating clinical factors and inflammatory markers can identify patients with severe obesity at high risk for persistent left ventricular dysfunction 1 year after bariatric surgery.
May support preoperative risk stratification in severe obesity; hypothesis-generating for inflammation-targeted LV recovery trials.
A large proportion of patients with severe obesity remain with left ventricular (LV) dysfunction after bariatric surgery. We assessed whether preoperative evaluation by echocardiography and inflammatory proteins can identify this high-risk group. In the Bariatric Surgery on the West Coast of Norway study, 75 patients (44 ± 10 years, body mass index [BMI] 41.5 ± 4.7 kg/m 2 ) were prospectively evaluated by echocardiography and inflammatory proteins (high-sensitivity C-reactive protein [hsCRP], serum amyloid A [SAA] and calprotectin) before and one year after Roux-en-Y gastric bypass surgery. LV mechanics was assessed by the midwall shortening (MWS) and global longitudinal strain (GLS). Bariatric surgery improved BMI and GLS, and lowered hsCRP, calprotectin and SAA (p < 0.05). MWS remained unchanged and 35% of patients had impaired MWS at 1-year follow-up. A preoperative risk index including sex, hypertension, ejection fraction (EF) and high hsCRP (index 1) or SAA (index 2) predicted low 1-year MWS with 81% sensitivity/71% specificity (index 1), and 77% sensitivity/77% specificity (index 2) in ROC analyses (AUC 0.80 and 0.79, p < 0.001). Among individuals with severe obesity, women and patients with hypertension, increased serum levels of inflammatory proteins and reduced EF are at high risk of impaired LV midwall mechanics 1 year after bariatric surgery. ClinicalTrials.gov identifier NCT01533142 February 15, 2012.
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Grymyr et al. (2024) conducted a cohort in Severe obesity with left ventricular dysfunction (n=75). Preoperative risk index (female sex, hypertension, low ejection fraction, and high hsCRP or SAA) vs. Lower risk index scores was evaluated on Impaired left ventricular midwall shortening (MWS) at 1-year follow-up (AUC 0.80, p=<0.001). A preoperative risk index including female sex, hypertension, low ejection fraction, and high hsCRP predicted impaired left ventricular midwall shortening 1 year after bariatric surgery with an AUC of 0.80.
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