Impact of Body Mass Index &gt;50 on Cardiac Structural and Functional Characteristics and Surgical Outcomes After Bariatric Surgery

Brownell, Nicholas; Rodríguez-Flores, Marcela; García-García, Eduardo; Ordoñez-Ortega, Samuel; Oseguera-Moguel, Jorge; Aguilar-Salinas, Carlos A.; Poirier, Paul

doi:10.1007/s11695-016-2199-8

Cited by 9 publications

(4 citation statements)

References 50 publications

(42 reference statements)

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“…In a larger study with 312 patients with higher BMI's, Brownell et al reported that the presence of LVH was independently associated with BMI ≥ 50 and female sex, after adjusting for age, diabetes, hypertension, and pulmonary hypertension [20]. As there was no significant LVH preoperatively in our group, we cannot confirm this.…”

Section: Discussioncontrasting

confidence: 64%

“…Due to the necessary increase of cardiac output, needed for enhanced blood supply to the excess peripheral tissue, obesity is associated with a chronic higher cardiac workload as compared to [2,18,19]. One of these studies was obtained in a group of patients with a BMI > 50, in contrast to our test group with a median BMI of 40.1 preoperatively [20]. As the blood supply to the peripheral tissue decreases after significant weight loss, it is expected that the cardiac workload will change, and therefore the cardiac function will improve after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

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Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

et al. 2020

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Purpose Metabolic syndrome in patients with morbid obesity causes a higher cardiovascular morbidity, eventually leading to left ventricular hypertrophy and decreased left ventricular ejection fraction (LVEF). Roux-en-Y gastric bypass (RYGB) is considered the gold standard modality for treatment of morbid obesity and might even lead to improved cardiac function. Our objective is to investigate whether cardiac function in patients with morbid obesity improves after RYGB. Materials and Methods In this single center pilot study, 15 patients with an uneventful cardiac history who underwent RYGB were included from May 2015 to March 2016. Cardiac function was measured by cardiac magnetic resonance imaging (CMRI), performed preoperatively and 3, 6, and 12 months postoperative. LVEF and myocardial mass and cardiac output were measured. Results A total of 13 patients without decreased LVEF preoperative completed follow-up (mean age 37, 48.0 ± 8.8). There was a significant decrease of cardiac output 12 months postoperative (8.3 ± 1.8 preoperative vs. 6.8 ± 1.8 after 12 months, P = 0.001). Average myocardial mass declined by 15.2% (P < 0.001). After correction for body surface area (BSA), this appeared to be nonsignificant (P = 0.36). There was a significant improvement of LVEF/BSA at 6 and 12 months postoperative (26.2 ± 4.1 preoperative vs. 28.4 ± 3.4 and 29.2 ± 3.6 respectively, both P = 0.002). Additionally, there was a significant improvement of stroke volume/BSA 12 months after surgery (45.8 ± 8.0 vs. 51.9 ± 10.7, P = 0.033). Conclusion RYGB in patients with morbid obesity with uneventful history of cardiac disease leads to improvement of cardiac function.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

et al. 2020

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“…A recent study revealed that BMI over 50 kg/m 2 was independently associated with female sex and left ventricle hypertrophy but not with hypertension, diabetes, or a higher rate of surgical complications [17]. This may explain why 66.1% of surgeons in this survey acknowledged that BMI over 50 kg/m 2 is an indication for thorough preoperative cardiac evaluation.…”

Section: Discussionmentioning

confidence: 80%

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

et al. 2022

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Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building.

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“…They found insulin resistance to be associated with abnormal cardiac function and structure independent of age, blood pressure and glucose intolerance. In another study by Brownell et al [27], they investigated the impact of obesity on cardiac structure and function in patients after bariatric surgery. They found patients with BMI ≥ 50 to be independently associated with left ventricle hypertrophy, however no independent association with hypertension and diabetes.…”

Section: Discussionmentioning

confidence: 99%

Dysglycemia and increased left ventricle mass in normotensive patients admitted with a first myocardial infarction: prognostic implications of dysglycemia during 14 years of follow-up

Pararajasingam

Løgstrup

Høfsten

et al. 2019

BMC Cardiovasc Disord

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Background Left ventricle mass (LVM) can be influenced by various conditions including hypertension and/or inherent cardiomyopathies. Dysglycemia is also thought to exert an anabolic effect on heart tissue by hyperinsulinemia and thereby promoting increased LVM. The primary aim of this study was to assess the influence of dysglycemia on LVM evaluated by an oral glucose tolerance test (OGTT) in patients admitted with a first myocardial infarction (MI) without hypertension. The secondary aim was to assess the impact of dysglycemia on major adverse cardiovascular events (MACE) and all-cause mortality during long-term follow-up. Methods Patients admitted with a first MI without known history of hypertension were included. All patients without previously known type 2 diabetes mellitus (T2DM) had a standardized 2-hour OGTT performed and were categorized as: normal glucose tolerance (NGT), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and newly detected T2DM (new T2DM). LVM was measured by echocardiography using Devereaux formula and indexed by body surface area. Multivariate linear regression analysis was used to assess the impact of confounders (dysglycemia by OGTT, known T2DM, age, sex and type of MI) on LVM. Cox proportional hazard model was used to assess the impact of dysglycemia on all-cause mortality and a composite endpoint of MACE (all-cause mortality, MI, revascularisation due to stable angina, coronary artery bypass graft, ischemic stroke or hemorrhagic stroke). Results Two-hundred-and-five patients were included and followed up to 14 years. In multivariate regression analysis, LVM was only significantly increased in patients categorized as new T2DM (β = 25.3; 95% CI [7.5–43.0]) and known T2DM (β = 37.3; 95% CI [10.0-64.5]) compared to patients with NGT. Patients with new T2DM showed higher rates of MACE and all-cause mortality compared to patients with IFG/IGT and NGT; however no significantly increased hazard ratio was detected. Conclusions Dysglycemia is associated with increasing LVM in normotensive patients with a first acute myocardial infarction and the strongest association was observed in patients with new T2DM and patients with known T2DM. Dysglycemia in normotensive patients with a first MI is not an independent predictor of neither MACE nor all-cause mortality during long-term follow-up compared to normotensive patients without dysglycemia. Electronic supplementary material The online version of this article (10.1186/s12872-019-1084-5) contains supplementary material, which is available to authorized users.

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Impact of Body Mass Index >50 on Cardiac Structural and Functional Characteristics and Surgical Outcomes After Bariatric Surgery

Abstract: Body mass index ≥50 kg/m was independently associated with female sex and LVH but not with hypertension, diabetes, or a higher rate of surgical complications.

Cited by 9 publications

References 50 publications

Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Dysglycemia and increased left ventricle mass in normotensive patients admitted with a first myocardial infarction: prognostic implications of dysglycemia during 14 years of follow-up

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