使用自动定量灌注 CMR 评估减肥手术对冠状动脉微血管功能的影响

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-11-01 DOI:10.1016/j.jcmg.2024.05.022

James D. Crane BMBS , George Joy PhD , Kristopher D. Knott MBBS , João B. Augusto MD , Clement Lau PhD , Anish N. Bhuva PhD , Andreas Seraphim PhD , Timothée Evain PhD , Louise A.E. Brown PhD , Amrit Chowdhary PhD , Tushar Kotecha PhD , Marianna Fontana PhD , Sven Plein PhD , Sasindran Ramar MS , Francesco Rubino MD , Peter Kellman PhD , Hui Xue PhD , Iain Pierce PhD , Rhodri H. Davies PhD , James C. Moon MD , Charlotte Manisty PhD

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引用次数: 0

摘要

背景：肥胖症患者的冠状动脉微血管功能受损，导致心肌功能障碍和心力衰竭。减肥手术可降低心血管死亡率和心力衰竭，但其机制尚不清楚：作者研究了减肥手术对肥胖症患者冠状动脉微血管功能的影响及其与代谢综合征的关系：方法：在减肥手术前和手术后6个月进行全自动定量灌注心脏磁共振和代谢指标检查：结果：与年龄和性别匹配的健康志愿者相比，38 名肥胖症患者的应激心肌血流量（MBF）较低（P = 0.001），心肌灌注储备较低（P < 0.001）。共有 27 名参与者在手术后 6 个月进行了配对随访。随访期间，代谢异常明显减少，包括平均体重指数降低了 11 ± 3 kg/m2 （P < 0.001），糖化血红蛋白降低了 9 mmol/mol（Q1-Q3：4-19 mmol/mol；P 结论：肥胖症患者的冠状动脉微血管功能受损，但通过减肥手术可以显著改善。微血管功能的改善与胰岛素抵抗的改善有关，但对于术前患有 2 型糖尿病的患者，改善效果会减弱。

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The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR

Background

Coronary microvascular function is impaired in patients with obesity, contributing to myocardial dysfunction and heart failure. Bariatric surgery decreases cardiovascular mortality and heart failure, but the mechanisms are unclear.

Objectives

The authors studied the impact of bariatric surgery on coronary microvascular function in patients with obesity and its relationship with metabolic syndrome.

Methods

Fully automated quantitative perfusion cardiac magnetic resonance and metabolic markers were performed before and 6 months after bariatric surgery.

Results

Compared with age- and sex-matched healthy volunteers, 38 patients living with obesity had lower stress myocardial blood flow (MBF) (P = 0.001) and lower myocardial perfusion reserve (P < 0.001). A total of 27 participants underwent paired follow-up 6 months post-surgery. Metabolic abnormalities reduced significantly at follow-up including mean body mass index by 11 ± 3 kg/m² (P < 0.001), glycated hemoglobin by 9 mmol/mol (Q1-Q3: 4-19 mmol/mol; P < 0.001), fasting insulin by 142 ± 131 pmol/L (P < 0.001), and hepatic fat fraction by 5.6% (Q1-Q3: 2.6%-15.0%; P < 0.001). Stress MBF increased by 0.28 mL/g/min (Q1-Q3: −0.02 to 0.75 mL/g/min; P = 0.003) and myocardial perfusion reserve by 0.13 (Q1-Q3: −0.25 to 1.10; P = 0.036). The increase in stress MBF was lower in those with preoperative type 2 diabetes mellitus (0.1 mL/g/min [Q1-Q3: −0.09 to 0.46 mL/g/min] vs 0.75 mL/g/min [Q1-Q3: 0.31-1.25 mL/g/min]; P = 0.002). Improvement in stress MBF was associated with reduction in fasting insulin (beta = −0.45 [95% CI: −0.05 to 0.90]; P = 0.03).

Conclusions

Coronary microvascular function is impaired in patients with obesity, but can be improved significantly with bariatric surgery. Improvements in microvascular function are associated with improvements in insulin resistance but are attenuated in those with preoperative type 2 diabetes mellitus.

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.