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Qin T, Geng Y. Echocardiographic insights into early obesity-related cardiomyopathy: Deciphering the silent distress of the heart. Asian J Surg 2024; 47:1558-1559. [PMID: 38092596 DOI: 10.1016/j.asjsur.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Tingting Qin
- Department of Ultrasound, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yaming Geng
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China.
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Sargsyan N, Chen JY, Aggarwal R, Fadel MG, Fehervari M, Ashrafian H. The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis. Int J Obes (Lond) 2024; 48:166-176. [PMID: 38007595 PMCID: PMC10824663 DOI: 10.1038/s41366-023-01412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery. OBJECTIVE To evaluate the effect of bariatric surgery on cardiac structure and function in patients before and after bariatric surgery. METHODS Systematic review and meta-analysis of studies reporting pre- and postoperative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery. RESULTS Eighty studies of 3332 patients were included. Bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096-0.149; p < 0.001) in left ventricular (LV) mass index, an increase of 0.155 (95% CI 0.106-0.205; p < 0.001) in E/A ratio, a decrease of 2.012 mm (95% CI 1.356-2.699; p < 0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62-1.69; p < 0.001) in LV diastolic dimension, and an increase of 1.636% (95% CI 0.706-2.566; p < 0.001) in LV ejection fraction after surgery. CONCLUSION Bariatric surgery led to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors.
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Affiliation(s)
- Narek Sargsyan
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK.
| | - Jun Yu Chen
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Ravi Aggarwal
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Michael G Fadel
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matyas Fehervari
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of General Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Huang S, Lan Y, Zhang C, Zhang J, Zhou Z. The Early Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review and Meta-Analysis. Obes Surg 2023; 33:453-468. [PMID: 36508155 DOI: 10.1007/s11695-022-06366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND This meta-analysis was performed to investigate how cardiac structures and functions change in the very early stage after bariatric surgery. MATERIALS AND METHODS We thoroughly searched the PubMed, Embase, Cochrane Library, and Web of Science databases for articles including patients who underwent bariatric surgery and examined the changes of their cardiac indices. Results were pooled by using Review Manager 5.1 and Stata 12.0. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were obtained. The I-squared (I2) test was used to determine the heterogeneity between studies. To identify publication bias, funnel plots and Egger's test were utilized. The leave-one-out method was used to conduct sensitivity analysis. RESULTS In this meta-analysis, 24 research including 942 patients were considered. According to our findings, most cardiac indices changed 3-6 months following bariatric surgery. An improvement in cardiac geometry was reflected by a reduction in left ventricular mass (LVM) (WMD = - 22.06, 95% CI = (- 27.97, - 16.16)). The left ventricular diastolic function improved, as reflected by the decrease in the E/e' ratio (WMD = - 0.90, 95% CI = (- 1.83, - 0.16)). Left ventricular ejection fraction (LVEF) did not show an obvious change (WMD = 0.94, 95% CI = (- 0.19, 2.07)), while a more sensitive indicator of left ventricular systolic function, left ventricular longitudinal strain (LV LS), increased (WMD = - 2.43, 95% CI = (- 3.96, - 0.89)). CONCLUSION This meta-analysis includes the newest and most comprehensive cardiac indices to prove that cardiac structures and functions are improved early after bariatric surgery, which has not been reported by any other studies.
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Affiliation(s)
- Shanya Huang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yi Lan
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Esparham A, Shoar S, Kheradmand HR, Ahmadyar S, Dalili A, Rezapanah A, Zandbaf T, Khorgami Z. The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and Diastolic Function in Patients with Obesity: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:345-361. [PMID: 36469205 DOI: 10.1007/s11695-022-06396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022]
Abstract
The purpose of this study was to provide pooled data from all studies on the impact of bariatric surgery on cardiac structure, and systolic and diastolic function evaluated by either echocardiography or cardiac magnetic resonance. PubMed, Web of Science, Embase, and Scopus databases were searched. Almost all of cardiac left-side structural indices improved significantly after bariatric surgery. However, right-side structural indices did not change significantly. Left ventricular ejection fraction and most of the diastolic function indices improved significantly after the bariatric surgery. The subgroup analysis showed that the left ventricular mass index decreased more in long-term follow-up (≥ 12 months). In addition, subgroup analysis of studies based on surgery type did not reveal any difference in outcomes between gastric bypass and sleeve gastrectomy groups.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Shoar
- Department of Clinical Research, ScientificWriting Corp, Houston, TX, USA
| | - Hamid Reza Kheradmand
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezapanah
- Department of Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of Surgery, School of Medicine, Islamic Azad University, Mashhad, Iran
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, OK, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Inci S, Gul M, Elcik D, Aktas H, Yildirim O, Kelesoglu S, Kalay N. Identification of subclinical myocardial dysfunction by Speckle Tracking Imaging in patients with myocardial infarction with non-occlusive coronary arteries (MINOCA). THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2099-2106. [PMID: 37726472 DOI: 10.1007/s10554-022-02602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to investigate subclinical left ventricular dysfunction in patients diagnosed with myocardial infarction with non-occlusive coronary arteries (MINOCA). METHODS Thirty-five patients with MINOCA (average age 54.26 ± 12.24 years) and thirty-five patients with ischemia with non-obstructed coronary artery disease (INOCA) (average age 55.20 ± 8.36 years) were enrolled in the study. All clinical conditions that could affect left ventricular functions were considered exclusion criteria. Echocardiographic studies were conducted in the patient and control groups in the left lateral decubitus position using a medical ultrasound device (EPIQ 7, Philips Medical System, USA). The left ventricle was examined longitudinally with apical images of chamber 4-3-2 using the available software (QLAB 6.0). RESULTS There were no differences in age, blood pressure level, baseline echocardiogram measurements, and tissue Doppler parameters between the two groups. In two-dimensional speckle tracking echocardiography (2D-STE) measurements, left ventricular longitudinal strain and strain rate in systole, early and late diastole from apical 4-3-2 chamber and global measurements of each parameter were significantly decreased in the MINOCA group compared to the INOCA group (p < 0.05). A significant negative correlation was observed between the global longitudinal strain rate and the troponin I in the MINOCA patients group (r=-0.43 p = 0.009). CONCLUSIONS Our study showed that while standard echocardiographic parameters for patients diagnosed with MINOCA were normal, their left ventricular systolic and diastolic functions were reduced by the 2D-STE method.
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Affiliation(s)
- Sinan Inci
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Gul
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey.
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Deniz Elcik
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Aktas
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Oguz Yildirim
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Saban Kelesoglu
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Gherbesi E, Cuspidi C, Faggiano A, Sala C, Carugo S, Tadic M. Bariatric Surgery and Myocardial Mechanics: A Meta-Analysis of Speckle Tracking Echocardiographic Studies. J Clin Med 2022; 11:jcm11164655. [PMID: 36012899 PMCID: PMC9410478 DOI: 10.3390/jcm11164655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
Aim: Current evidence on the effects of bariatric surgery on cardiac mechanics in patients with obesity is based on a few single studies. We investigated this issue through a meta-analysis of speckle tracking echocardiography (STE) studies that reported data on changes in left ventricular (LV) mechanics as assessed by global longitudinal strain (GLS). Methods: The PubMed, OVID-MEDLINE and Cochrane library databases were systematically analysed to search English-language articles published from inception to 31 May 2022. Studies were identified by using Me-SH terms and crossing the following terms: “obesity”, “bariatric surgery”, “left ventricular mechanics”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “echocardiography” and “STE echocardiography”. Results: The meta-analysis, including a total of 512 patients with obesity from 13 studies (follow-up 1−23 months), showed a significant GLS improvement after bariatric procedures, with standard mean difference (SMD) being 0.50 ± 0.08, CI: 0.34/0.65, p < 0.0001. Corresponding SMD value for LV ejection fraction (LVEF) was 0.15 ± 0.09, CI: −0.04/0.34, p = 0.11. A sensitivity analysis restricted to 11 studies with follow-up ≥ 6 months confirmed that GLS (SMD: 0.47 ± 0.08, CI: 0.30/0.63, p < 0.0001) but not LVEF (SMD: 0.14 ± 0.11, CI: −0.08/0.37, p = 0.21) improved after surgery. Conclusions: Our meta-analysis adds a new piece of information on the beneficial effects of bariatric surgery on LV systolic function and, more importantly, suggests that the assessment of myocardial strain should be routinely implemented for a comprehensive evaluation of cardiac functional changes associated with bariatric procedures.
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Affiliation(s)
- Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, 20122 Milan, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, 20122 Milan, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, 20122 Milan, Italy
| | - Stefano Carugo
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Centre “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-658107085
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