Favorable Changes in Cardiac Geometry and Function Following Gastric Bypass Surgery 2-Year Follow-Up in the Utah Obesity Study

Division of Cardiology, University of Utah School of Medicine, Salt Lake City, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 02/2011; 57(6):732-9. DOI: 10.1016/j.jacc.2010.10.017
Source: PubMed


The objective of this study was to test the hypothesis that gastric bypass surgery (GBS) would favorably impact cardiac remodeling and function.
GBS is increasingly used to treat severe obesity, but there are limited outcome data.
We prospectively studied 423 severely obese patients undergoing GBS and a reference group of severely obese subjects that did not have surgery (n = 733).
At a 2-year follow up, GBS subjects had a large reduction in body mass index compared with the reference group (-15.4 ± 7.2 kg/m(2) vs. -0.03 ± 4.0 kg/m(2); p < 0.0001), as well as significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density lipoprotein cholesterol, and insulin resistance. High-density lipoprotein cholesterol increased. The GBS group had reductions in left ventricular (LV) mass index and right ventricular (RV) cavity area. Left atrial volume did not change in GBS but increased in reference subjects. In conjunction with reduced chamber sizes, GBS subjects also had increased LV midwall fractional shortening and RV fractional area change. In multivariable analysis, age, change in body mass index, severity of nocturnal hypoxemia, E/E', and sex were independently associated with LV mass index, whereas surgical status, change in waist circumference, and change in insulin resistance were not.
Marked weight loss in patients undergoing GBS was associated with reverse cardiac remodeling and improved LV and RV function. These data support the use of bariatric surgery to prevent cardiovascular complications in severe obesity.

Download full-text


Available from: Robert Farney, Jun 07, 2014
  • Source
    • "LVMI but not RWT was significantly reduced in the surgical group, suggesting that the left ventricular hypertrophy in obese T2DM with hypertension may be alleviated by RYGB surgery. Our results are consistent with the results previously reported by Owan et al. [16] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims: The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass (RYGB) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus (T2DM) and hypertension. Methods: 108 obese T2DM with hypertension were enrolled and randomly allocated to usual care (group A), usual care plus Exenatide (group B), and RYGB surgery (group C). Demographic characteristics, metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months. Results: At 12 months, diabetes remission had occurred in no patients in groups A and B versus 90% in group C, and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B (P<0.05). Other parameters (body mass index, hemoglobin A1c, homeostasis model assessment of insulin resistance, lipids), inflammation index (high sensitivity C-reactive protein, tumor necrosis factor-α, high molecular weight adiponectin) and cardiac structure (left ventricular mass index) were significantly improved in groups B and C, but patients in group C had the greatest degree of improvement (P<0.05). Conclusion: RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM. This is likely to be due to, at least in part, an improvement in the abnormal metabolic panel and to reduced inflammation.
    Full-text · Article · May 2013 · Diabetes research and clinical practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is an independent risk factor for the development of coronary heart disease and chronic heart failure. It is associated with hypertension, dyslipidemia, and insulin resistance, in addition to vascular endothelial cell dysfunction and a proinflammatory prothrombotic state. Obesity furthermore, is associated with left ventricular remodeling leading to hypertrophy and diastolic and systolic dysfunction. Intentional weight loss of as little at 5% to 10% body weight improves cardiac and vascular function, blood pressure control, lipid profile, insulin resistance, diabetes control, and prevents or delays the onset of type 2 diabetes mellitus. These reductions in cardiovascular risk factors and improvements in cardiovascular function are seen with intentional weight loss achieved by any combination of exercise, calorie-restriction, behavioral weight loss programs, pharmacologic-induced, and surgical procedures. This review focuses on the cardiovascular effects of intentional weight loss achieved through intensive lifestyle modifications.
    No preview · Article · Feb 2011 · Current Cardiovascular Risk Reports

  • No preview · Article · Apr 2011 · Nature Reviews Cardiology
Show more