scholarly journals One-year impact of bariatric surgery on left ventricular mechanics: results from the prospective FatWest study

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Lisa M D Grymyr ◽  
Saied Nadirpour ◽  
Eva Gerdts ◽  
Bjørn G Nedrebø ◽  
Johannes Just Hjertaas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Heart Rate ◽  
Oxygen Demand ◽  
Left Ventricular ◽  
Myocardial Oxygen Demand ◽  
Rapid Weight Loss ◽  
Obese Patients ◽  
Lv Mass ◽  
Severely Obese ◽  
One Year

Abstract Aims Patients with severe obesity are predisposed to left ventricular (LV) hypertrophy, increased myocardial oxygen demand, and impaired myocardial mechanics. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. The present prospective study assesses whether LV wall mechanics improve 1 year after bariatric surgery. Methods and results Ninety-four severely obese patients [43 ± 10 years, 71% women, body mass index (BMI) 41.8 ± 4.9 kg/m2, 57% with hypertension] underwent echocardiography before, 6 months and 1 year after gastric bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), LV power/mass as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, and myocardial oxygen demand as the LV mass-wall stress-heart rate product. Surgery induced a significant reduction in BMI, heart rate, and BP (P < 0.001). Prevalence of LV hypertrophy fell from 35% to 19% 1 year after surgery (P < 0.001). The absolute value of GLS improved by—4.6% (i.e. 29% increase in GLS) while LV ejection fraction, MWS, and LV power/mass remained unchanged. In multivariate regression analyses, 1 year improvement in GLS was predicted by lower preoperative GLS, larger mean BP, and BMI reduction (all P < 0.05). Low 1-year MWS was associated with female sex, preoperative hypertension, and higher 1-year LV relative wall thickness and myocardial oxygen demand (all P < 0.001). Conclusion In severely obese patients, LV longitudinal function is largely recovered one year after bariatric surgery due to reduced afterload. LV midwall mechanics does not improve, particularly in women and patients with persistent LV geometric abnormalities. ClinicalTrials.gov identifier NCT01533142, 15 February 2012.

Abstract 16319: Large Weight Loss Improves Left Ventricular Geometry but Not Myocardial Function 6 Months After Bariatric Surgery (the Fatwest Study)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lisa M Grymyr ◽  
Saied Nadirpour ◽  
Eva Gerdts ◽  
Johannes Hjertaas ◽  
Bjørn Nedrebø ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Heart Rate ◽  
Weight Loss ◽  
Systolic Function ◽  
Wall Stress ◽  
Left Ventricular ◽  
Obese Patients ◽  
Large Weight Loss ◽  
Lv Mass ◽  
Severely Obese

Background: Bariatric surgery causes rapid and large weight loss and improves cardiovascular risk profile, yet the effect on left ventricular (LV) systolic function has been less explored. Methods: In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study 98 severely obese patients (44±10 years, 72% women, preoperative body mass index [BMI] 41.8±4.8 kg/m 2 , 36% with hypertension) underwent echocardiography before and 5.9 months after gastric bypass surgery. We assessed changes in LV geometry and systolic function by biplane ejection fraction (EF), midwall shortening (MWS) and mitral annular systolic velocity (s′). LV hypertrophy was defined based on LV mass/height 2.7 . Myocardial O 2 demand was derived from the LV mass-wall stress-heart rate product. Results: Patients experienced on average a 10 kg/m 2 reduction in BMI, and a significant drop in heart rate and blood pressure (all p<0.001). LV mass (-12 g) and myocardial O 2 demand improved significantly (all p<0.01). However, LV EF (60 vs. 61%), s’ (8.5 vs. 8.3cm/s) and MWS (16.1 vs. 15.7%) remained unchanged, and 45% of patients had low MWS 6 months after surgery (Figure). In multivariable regression analyses, LV mass reduction was predicted by weight loss and female sex, independent of changes in blood pressure and heart rate (R 2 0.24, p <0.001) while lower myocardial O2 demand was explained by improvement in its three components, particularly lower LV end-systolic wall stress (R 2 0.9, p<0.001). Conclusion: In severely obese patients with normal EF, bariatric surgery induces a significant reduction in BMI, LV mass and myocardial O 2 demand, but no improvement in LV myocardial systolic function 6 months after surgery.

scholarly journals Incomplete functional reverse remodelling of the left ventricle one year after bariatric surgery. Insights from the prospective FatWest study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L M D Grymyr ◽  
S Nadirpour ◽  
E Gerdts ◽  
B G Nedreboe ◽  
J J Hjertaas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Systolic Function ◽  
Oxygen Demand ◽  
Female Gender ◽  
Myocardial Oxygen Demand ◽  
Cardiac Power ◽  
Lv Mass ◽  
Severely Obese ◽  
Lv Systolic Function ◽  
Concentric Geometry

Abstract Background Patients with severe obesity are predisposed to development of left ventricular (LV) hypertrophy with subsequent increased myocardial oxygen demand and impaired myocardial function. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. Purpose To assess whether LV systolic function, wall mechanics, and cardiac power improve 1 year after bariatric surgery. Methods 91 severely obese patients (43±10 years, 70% women, body mass index [BMI] 41.7±4.9 kg/m2, 55% with hypertension, 17% with diabetes mellitus) underwent echocardiography before, 6 and 14 months after Roux-en-Y gastric bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV systolic function by biplane ejection fraction (EF), LV wall mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), and cardiac power normalized for LV mass by 0.222 x cardiac output x mean blood pressure (BP)/LV mass. Results Surgery induced a significant reduction in BMI, heart rate, systolic BP, and LV mass (Figure 1). Prevalence of LV hypertrophy fell from 34 to 20% 14 months after surgery (p&lt;0.001), while that of concentric geometry remained stable: 8 vs 10% (p=0.36). GLS improved by 28%, however LV EF and MWS did not change (Figure 2). LV power at rest decreased postoperatively, reflecting the lower BP and heart rate, but was unaltered when normalized for LV mass (Figure 2). In backward stepwise multivariate regression analyses, 1 year improvement in GLS was predicted by the systolic BP reduction (p&lt;0.05) (R2 0.73, p&lt;0.001), while low 1-year MWS was independently associated with female gender, concentric geometry and higher myocardial oxygen demand (all p&lt;0.01) (Nagelkerke R2 0.44, p&lt;0.001), and lower 1-year LV power-mass with female gender and LV hypertrophy (p&lt;0.01) (R2 0.24, p&lt;0.001). Conclusion In severely obese patients, LV longitudinal function normalizes 1 year after bariatric surgery, mainly due to the BP reduction. LV midwall mechanics and power do not improve, especially in women and patients with persistent LV geometric abnormalities. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Higher left ventricular mass–wall stress–heart rate product and outcome in aortic valve stenosis

Heart ◽  
2019 ◽  
Vol 105 (21) ◽  
pp. 1629-1633 ◽  
Author(s):  
Eva Gerdts ◽  
Sahrai Saeed ◽  
Helga Midtbø ◽  
Anne Rossebø ◽  
John Boyd Chambers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Cox Regression ◽  
Oxygen Demand ◽  
Wall Stress ◽  
Left Ventricular ◽  
Adverse Event Rate ◽  
Myocardial Oxygen Demand ◽  
Lv Mass ◽  
All Cause Mortality

ObjectiveWhether increased myocardial oxygen demand could help explain the association of left ventricular (LV) hypertrophy with higher adverse event rate in patients with aortic valve stenosis (AS) is unknown.MethodsData from 1522 patients with asymptomatic mostly moderate AS participating in the Simvastatin-Ezetimibe in AS study followed for a median of 4.3 years was used. High LV mass–wall stress–heart rate product was identified as >upper 95% CI limit in normal subjects. The association of higher LV mass–wall stress–heart rate product with major cardiovascular (CV) events, combined CV death and hospitalised heart failure and all-cause mortality was tested in Cox regression analyses, and reported as HR and 95% CI.ResultsHigh LV mass–wall stress–heart rate product was found in 19% at baseline, and associated with male sex, higher body mass index, hypertension, LV hypertrophy, more severe AS and lower LV ejection fraction (all p<0.01). Adjusting for these confounders in time-varying Cox regression analysis, 1 SD higher LV mass–wall stress–heart rate product was associated with higher HR of major CV events (HR 1.16(95% CI 1.06 to 1.29)), combined CV death and hospitalised heart failure (HR 1.29(95% CI 1.09 to 1.54)) and all-cause mortality (HR 1.34(95% CI 1.13 to 1.58), all p<0.01).ConclusionIn patients with initially mild–moderate AS, higher LV mass–wall stress–heart rate product was associated with higher mortality and heart failure hospitalisation. Our results suggest that higher myocardial oxygen demand is contributing to the higher adverse event rate reported in AS patients with LV hypertrophy.Trial registration numberNCT000092677;Post-results.

scholarly journals P1514 Increased myocardial oxygen demand is associated with impaired left ventricular strain in patients with morbid obesity referred for bariatric surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L M Grymyr ◽  
S Nadirpour ◽  
E Gerdts ◽  
B G Nedreboe ◽  
J J Hjertaas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pulse Pressure ◽  
Systolic Function ◽  
Oxygen Demand ◽  
Wall Stress ◽  
Left Ventricular ◽  
Myocardial Oxygen Demand ◽  
Lv Mass ◽  
Obese Subjects ◽  
Lv Systolic Function

Abstract Background Obesity predisposes for left ventricular (LV) hypertrophy and systolic dysfunction. Higher myocardial oxygen demand in LV hypertrophy is associated with higher risk for cardiovascular events, while the association with LV systolic function has been less explored. Purpose To assess the association of myocardial oxygen demand with LV systolic function in morbidly obese subjects without known heart disease. Methods Clinical and echocardiographic data from 110 obese subjects referred for gastric bypass surgery (mean age 42 ± 11 years, 74% women, mean body mass index [BMI] 41.9 ± 4.8 kg/m², 33% with hypertension, 15% with diabetes) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV function was assessed by ejection fraction (EF) by Simpson"s biplane method and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model (Image Arena 4.6, Tomtec, Unterschleissheim, Germany). Myocardial oxygen demand was estimated from LV mass - wall stress - heart rate product according to a previously validated formula. Results Myocardial oxygen demand was higher in men (1884 vs. 1579 x 10³ g x kdyne/cm² x bpm, p &lt; 0.05), and associated with higher BMI (r = 0.24) and pulse pressure (r = 0.28), and with lower EF (r = -0.22) and lower GLS (r = 0.26, all p &lt; 0.05). In multiple regression analysis, higher myocardial oxygen demand was associated with lower LV GLS (Beta = 0.21, p &lt; 0.05) independent of age, gender, BMI, pulse pressure, diabetes, and EF (Table). Conclusion In obese patients without known heart disease referred for bariatric surgery, higher myocardial oxygen demand was associated with lower LV systolic function measured by GLS independent of confounders. Covariates of lower GLS in multivariable Variable β correlation coefficient p LV mass - wall stress - heart rate product (g x kdyne/cm&sup2; x bpm x 10&sup3;) 0.21 0.04 Age (years) -0.12 0.22 Gender 0.34 &lt;0.01 BMI (kg/m&sup2;) 0.25 &lt;0.01 Pulse pressure (mmHg) -0.04 0.71 Diabetes -0.17 0.09 LV EF (%) -0.01 0.90

Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease

2019 ◽  
Vol 34 (7) ◽  
pp. 3197-3203 ◽  
Author(s):  
Camila Ortiz-Gomez ◽  
David Romero-Funes ◽  
David Gutierrez-Blanco ◽  
Joel S. Frieder ◽  
Maria Fonseca-Mora ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Chronic Kidney Disease ◽  
Weight Loss ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Rapid Weight Loss ◽  
Obese Patients ◽  
Severely Obese

scholarly journals Predictive score of sarcopenia occurrence one year after bariatric surgery in severely obese patients

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0197248 ◽  
Author(s):  
Cosmin Sebastian Voican ◽  
Amandine Lebrun ◽  
Sophie Maitre ◽  
Panagiotis Lainas ◽  
Karima Lamouri ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Predictive Score ◽  
Obese Patients ◽  
Severely Obese ◽  
One Year

Abstract P084: Influence Of Amount And Rapidity Of Weight Loss On The Risk Of Subsequently Regaining Weight And Drop-out From Treatment Among Patients With Severe Obesity Dieting In Hospital Without Bariatric Surgery

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Tomohide Yamada ◽  
Kazuo Hara ◽  
Takashi Kadowaki
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Severe Obesity ◽  
Cohort Analysis ◽  
Antidepressant Medication ◽  
Drop Out ◽  
Rapid Weight Loss ◽  
Obese Patients ◽  
Duration Of Hospitalization ◽  
Severely Obese

Although many obese patients with type 2 diabetes lose weight by dieting, most subsequently regain it. We performed a retrospective cohort analysis to assess the influence of the amount and rapidity of weight loss during hospitalization on the risk of subsequently regaining weight and stopping treatment in patients with severe obesity who dieted without bariatric surgery. A total of 131 severely obese patients (48±14 years old; BMI: 41.7±8.8; 75% with diabetes) received inpatient treatment that included diet, exercise, behavioral modification (charting weight four times daily), and educational seminars, and were followed after discharge. Regaining weight and drop-out were defined as returning to baseline body weight and failing to keep outpatient appointments, respectively. Patients lost an average of 5.3±3.0kg (4.9±2.4%) in hospital (mean: 19 days). Over the median 2-year follow-up period, unadjusted analysis showed that patients with >3% weight loss in hospital had significantly less risk of regaining weight than patients losing≤3%. The risk decreased further with greater weight loss (>7% loss; hazard ratio (HR):0.06; 95% confidence interval:0.007-0.47). Adjusted analysis revealed that >5% weight loss was associated with significantly less risk of regaining weight after adjustment for age, sex, BMI, smoke, diabetes, insulin, sulfonylurea, antidepressant medication, and duration of hospitalization (>7% loss; HR 0.04(0.004-0.36, p=0.004), 7%≥loss>5%; HR 0.3(0.11-0.85, p=0.02)). No significant relation was observed between weight loss and drop-out. Among patients with >3% weight loss during hospitalization, rapid weight loss (>3% within 7 days) did not increase the risk of subsequently regaining weight compared with patients showing slower weight loss. In conclusion, achieving >5% weight loss during comparatively brief hospitalization predicts subsequent maintenance of lower weight. Experiencing success in hospital might increase the motivation of obese patients.

Reflex cardiac effects of local cutaneous cold exposure in dogs

1980 ◽  
Vol 239 (1) ◽  
pp. H114-H120
Author(s):  
J. F. Borgia ◽  
S. M. Horvath
Keyword(s):  
Heart Rate ◽  
Cardiac Contractility ◽  
Oxygen Demand ◽  
Cardiovascular Responses ◽  
Left Ventricular ◽  
Myocardial Oxygen Demand ◽  
Adrenergic Blockade ◽  
Stroke Index ◽  
Ventricular Contractility ◽  
Cold Stimulation

Cardiovascular responses initiated by local cutaneous cooling were evaluated in 16 anesthetized dogs of which 8 were pretreated with propranolol. Heart rate, cardiac index (CI), and indices of ventricular contractility were significantly elevated in untreated animals during cold stimulation. Myocardial oxygen uptake (MVo2) and left ventricular work (LVW) were also increased, and cardiac mechanical efficiency was significantly reduced. Total peripheral vascular resistance remained unchanged. In the propranolol group, heart rate decreased by 12 beats/min, but CI was maintained constant during cold by a rise in stroke index. Left ventricular dP/dtmax was reduced and ventricular preload elevated, but LVW, MVo2, and cardiac efficiency were unchanged. These data indicate that local cutaneous cooling increases myocardial oxygen demand by reflexly elevating heart rate and cardiac contractility rather than by increasing cardiac afterload. The response is completely eliminated by beta-adrenergic blockade. The significance of these observations in regard to the cold-intolerant individual with coronary disease is discussed.

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