December 19, 2012
View Full PaperCardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy
Key Result
Laparoscopic sleeve gastrectomy significantly reduced left ventricular mass index from 55.9 to 43.8 g/m2.7 (p=0.0004) and improved metabolic profiles at 12-20 months follow-up.
Study Design
Type
Observational (n=16)
Structured PICO
Does laparoscopic sleeve gastrectomy improve cardiac remodeling and cardiovascular risk factors in obese patients?
P
Population
16 obese patients (75% female, mean age 46.4 years) undergoing laparoscopic sleeve gastrectomy, evaluated preoperatively and 12-20 months postoperatively.
E
Exposure
Laparoscopic sleeve gastrectomy (LSG)
O
Outcome
Cardiac reverse remodeling evaluated by echocardiography, amount of cardiovascular medications, and impact of co-morbiditiessurrogate
Laparoscopic sleeve gastrectomy in obese patients is associated with significant cardiac reverse remodeling and reduction in cardiovascular risk factors at medium-term follow-up.
Main Result
p-value: p=0.0004
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/m(2.7) (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.