Effects of Bariatric Surgery on Cardiovascular Function
Effects of Bariatric Surgery on Cardiovascular Function
The mean age of the patients was 53·7 ± 8·9 years and mean duration of type 2 diabetes was 13·9 ± 8·2 years. Clinical and metabolic parameters before and after bariatric surgery are shown in Table 1. BMI decreased from 41·3 ± 4·3 at baseline to 34·1 ± 2·8 kg/m (P < 0·001) 16 weeks after bariatric surgery. After the RYGB, glycemic control was significantly improved, as shown by a decrease in HbA1c from 7·8 ± 1·1 to 6·8 ± 1·3% (62 ± 12 to 51 ± 14 mm;P < 0·05). According to the inclusion criteria, all patients used insulin at baseline. After 16 weeks, the average total daily dose of insulin decreased from 134 ± 66 units at baseline to 26 ± 25 units. Two patients were able to discontinue insulin treatment completely.
Results from the MR studies are shown in Table 2 and Table 3. Due to technical difficulties MRI data are not available for all patients (see tables for details on specific scans).
Pericardial fat volume decreased 16 weeks after the RYGB. When the two pericardial fat compartments (epicardial and paracardial fat) were assessed separately, a significant reduction in both fat depots was shown (Table 2). A difference in proportional decreases was seen, with a higher relative proportional decrease in paracardial (−17·3 ± 17·2%) as compared to epicardial (−6·4 ±6·0%) fat volume (Fig. 1). Myocardial TG content decreased as well; however, this did not reach statistical significance.
(Enlarge Image)
Figure 1.
Relative changes in fat depots 16 weeks after RYGB. The relative changes in epicardial, paracardial, visceral and subcutaneous abdominal fat volume. *P < 0·05 significant change in fat volume compared to baseline. RYGB, Roux-en-Y gastric bypass.
After the RYGB, the visceral and subcutaneous fat volumes were significantly reduced. There was a higher relative decrease in visceral as compared to subcutaneous fat volume, as reflected by a decrease in the visceral/subcutaneous fat ratio (Table 2 and Fig. 1).
Parameters for cardiac dimensions and systolic and diastolic function are shown in Table 3. Sixteen weeks after RYGB the parameters of systolic and diastolic cardiac function had not changed significantly. However, a trend was seen for a decrease in PVW (baseline: 7·5 ± 1·5; 16 weeks: 6·2 ± 0·8; P = 0·055).
Results
Clinical and Metabolic Characteristics
The mean age of the patients was 53·7 ± 8·9 years and mean duration of type 2 diabetes was 13·9 ± 8·2 years. Clinical and metabolic parameters before and after bariatric surgery are shown in Table 1. BMI decreased from 41·3 ± 4·3 at baseline to 34·1 ± 2·8 kg/m (P < 0·001) 16 weeks after bariatric surgery. After the RYGB, glycemic control was significantly improved, as shown by a decrease in HbA1c from 7·8 ± 1·1 to 6·8 ± 1·3% (62 ± 12 to 51 ± 14 mm;P < 0·05). According to the inclusion criteria, all patients used insulin at baseline. After 16 weeks, the average total daily dose of insulin decreased from 134 ± 66 units at baseline to 26 ± 25 units. Two patients were able to discontinue insulin treatment completely.
MRI and MRS Studies
Results from the MR studies are shown in Table 2 and Table 3. Due to technical difficulties MRI data are not available for all patients (see tables for details on specific scans).
Fat Compartments
Pericardial fat volume decreased 16 weeks after the RYGB. When the two pericardial fat compartments (epicardial and paracardial fat) were assessed separately, a significant reduction in both fat depots was shown (Table 2). A difference in proportional decreases was seen, with a higher relative proportional decrease in paracardial (−17·3 ± 17·2%) as compared to epicardial (−6·4 ±6·0%) fat volume (Fig. 1). Myocardial TG content decreased as well; however, this did not reach statistical significance.
(Enlarge Image)
Figure 1.
Relative changes in fat depots 16 weeks after RYGB. The relative changes in epicardial, paracardial, visceral and subcutaneous abdominal fat volume. *P < 0·05 significant change in fat volume compared to baseline. RYGB, Roux-en-Y gastric bypass.
After the RYGB, the visceral and subcutaneous fat volumes were significantly reduced. There was a higher relative decrease in visceral as compared to subcutaneous fat volume, as reflected by a decrease in the visceral/subcutaneous fat ratio (Table 2 and Fig. 1).
Cardiovascular Function
Parameters for cardiac dimensions and systolic and diastolic function are shown in Table 3. Sixteen weeks after RYGB the parameters of systolic and diastolic cardiac function had not changed significantly. However, a trend was seen for a decrease in PVW (baseline: 7·5 ± 1·5; 16 weeks: 6·2 ± 0·8; P = 0·055).