Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Knut Matre, Dana Cramariuc
{"title":"减肥手术后左心几何、力学和需氧量的长期轨迹。","authors":"Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Knut Matre, Dana Cramariuc","doi":"10.1161/CIRCHEARTFAILURE.124.012367","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The long-term impact of bariatric surgery on cardiac mechanics and energetics has been scarcely documented. We aimed to assess prospectively the 5-year trajectories of left heart geometry, mechanics, and myocardial oxygen (O<sub>2</sub>) demand after bariatric surgery.</p><p><strong>Methods: </strong>In the Bariatric Surgery on the West Coast of Norway study, left ventricular (LV) and atrial remodeling was evaluated preoperatively, 6 months, and 1 and 5 years after Roux-en-Y gastric bypass in 102 patients. LV geometry was assessed by the LV mass/height<sup>2.7</sup> and the relative wall thickness, and mechanics by the global longitudinal strain and the midwall shortening. LV myocardial O<sub>2</sub> demand was estimated from the product LV mass×wall stress×heart rate. The left atrial reservoir function was measured by the emptying fraction.</p><p><strong>Results: </strong>After 63 (interquartile range, 62-66) months, LV mass index, global longitudinal strain, myocardial oxygen demand, and left atrial emptying fraction were improved (<i>P</i><0.001) while midwall shortening did not change significantly. Prevalence of normal LV geometry increased from 61% to 82%. In linear mixed-effects models with adjustment for clinical characteristics, improving global longitudinal strain and myocardial O<sub>2</sub> demand over time were associated with female sex and lower body mass index (<i>P</i><0.05). In logistic regression analysis, 5-year presence of abnormal LV geometry, low LV global longitudinal strain, or high myocardial O<sub>2</sub> demand was related to preoperative diabetes, hypertension, and higher body mass index, as well as higher 5-year systolic blood pressure (<i>P</i><0.05; Nagelkerke R<sup>2</sup>=0.40).</p><p><strong>Conclusions: </strong>Bariatric surgery results in favorable 5-year trajectories of LV geometry, myocardial O<sub>2</sub> demand, and left heart longitudinal mechanics. However, suboptimal postoperative body mass index and blood pressure control promote long-term LV structural disease.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01533142.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012367"},"PeriodicalIF":8.4000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084020/pdf/","citationCount":"0","resultStr":"{\"title\":\"Long-Term Trajectories of Left Heart Geometry, Mechanics, and Oxygen Demand After Bariatric Surgery.\",\"authors\":\"Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Knut Matre, Dana Cramariuc\",\"doi\":\"10.1161/CIRCHEARTFAILURE.124.012367\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The long-term impact of bariatric surgery on cardiac mechanics and energetics has been scarcely documented. We aimed to assess prospectively the 5-year trajectories of left heart geometry, mechanics, and myocardial oxygen (O<sub>2</sub>) demand after bariatric surgery.</p><p><strong>Methods: </strong>In the Bariatric Surgery on the West Coast of Norway study, left ventricular (LV) and atrial remodeling was evaluated preoperatively, 6 months, and 1 and 5 years after Roux-en-Y gastric bypass in 102 patients. LV geometry was assessed by the LV mass/height<sup>2.7</sup> and the relative wall thickness, and mechanics by the global longitudinal strain and the midwall shortening. LV myocardial O<sub>2</sub> demand was estimated from the product LV mass×wall stress×heart rate. The left atrial reservoir function was measured by the emptying fraction.</p><p><strong>Results: </strong>After 63 (interquartile range, 62-66) months, LV mass index, global longitudinal strain, myocardial oxygen demand, and left atrial emptying fraction were improved (<i>P</i><0.001) while midwall shortening did not change significantly. Prevalence of normal LV geometry increased from 61% to 82%. In linear mixed-effects models with adjustment for clinical characteristics, improving global longitudinal strain and myocardial O<sub>2</sub> demand over time were associated with female sex and lower body mass index (<i>P</i><0.05). In logistic regression analysis, 5-year presence of abnormal LV geometry, low LV global longitudinal strain, or high myocardial O<sub>2</sub> demand was related to preoperative diabetes, hypertension, and higher body mass index, as well as higher 5-year systolic blood pressure (<i>P</i><0.05; Nagelkerke R<sup>2</sup>=0.40).</p><p><strong>Conclusions: </strong>Bariatric surgery results in favorable 5-year trajectories of LV geometry, myocardial O<sub>2</sub> demand, and left heart longitudinal mechanics. However, suboptimal postoperative body mass index and blood pressure control promote long-term LV structural disease.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01533142.</p>\",\"PeriodicalId\":10196,\"journal\":{\"name\":\"Circulation: Heart Failure\",\"volume\":\" \",\"pages\":\"e012367\"},\"PeriodicalIF\":8.4000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084020/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Heart Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCHEARTFAILURE.124.012367\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCHEARTFAILURE.124.012367","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Long-Term Trajectories of Left Heart Geometry, Mechanics, and Oxygen Demand After Bariatric Surgery.
Background: The long-term impact of bariatric surgery on cardiac mechanics and energetics has been scarcely documented. We aimed to assess prospectively the 5-year trajectories of left heart geometry, mechanics, and myocardial oxygen (O2) demand after bariatric surgery.
Methods: In the Bariatric Surgery on the West Coast of Norway study, left ventricular (LV) and atrial remodeling was evaluated preoperatively, 6 months, and 1 and 5 years after Roux-en-Y gastric bypass in 102 patients. LV geometry was assessed by the LV mass/height2.7 and the relative wall thickness, and mechanics by the global longitudinal strain and the midwall shortening. LV myocardial O2 demand was estimated from the product LV mass×wall stress×heart rate. The left atrial reservoir function was measured by the emptying fraction.
Results: After 63 (interquartile range, 62-66) months, LV mass index, global longitudinal strain, myocardial oxygen demand, and left atrial emptying fraction were improved (P<0.001) while midwall shortening did not change significantly. Prevalence of normal LV geometry increased from 61% to 82%. In linear mixed-effects models with adjustment for clinical characteristics, improving global longitudinal strain and myocardial O2 demand over time were associated with female sex and lower body mass index (P<0.05). In logistic regression analysis, 5-year presence of abnormal LV geometry, low LV global longitudinal strain, or high myocardial O2 demand was related to preoperative diabetes, hypertension, and higher body mass index, as well as higher 5-year systolic blood pressure (P<0.05; Nagelkerke R2=0.40).
Conclusions: Bariatric surgery results in favorable 5-year trajectories of LV geometry, myocardial O2 demand, and left heart longitudinal mechanics. However, suboptimal postoperative body mass index and blood pressure control promote long-term LV structural disease.
期刊介绍：
Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.
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