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The effect of bariatric surgery type on cardiac reverse remodelling
J A Henry1, I Abdesselam2, O Deal2
1Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. john.henry@some.ox.ac.uk.
Insights
Roux-en-Y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy (LSG) significantly reduce visceral fat and reverse cardiac remodelling more effectively than Laparoscopic Adjustable Gastric Band (LAGB) surgery.
Area of Science:
- Cardiology
- Bariatric Surgery
- Obesity Medicine
Background:
- Obesity is linked to adverse cardiac remodelling.
- Bariatric surgery aids in reversing cardiac changes associated with obesity.
Purpose of the Study:
- To compare the effectiveness of three bariatric procedures: Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG), and Laparoscopic Adjustable Gastric Band (LAGB).
- To assess their impact on reversing cardiac remodelling in obese patients.
Main Methods:
- Cardiac Magnetic Resonance (CMR) imaging was used to evaluate left ventricular mass (LVM), LV mass:volume ratio (LVMVR), and LV eccentricity index (LVei).
- Abdominal visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) were measured before and after surgery.
- Follow-up included short-term (median 251-273 days) and longer-term (median 983-1027 days) assessments.
Main Results:
- All procedures led to significant excess weight loss (48-70%).
- RYGB and LSG showed greater reductions in VAT and EAT compared to LAGB.
- RYGB and LSG resulted in more significant decreases in LVM, LVMVR, and LVei compared to LAGB, indicating greater reverse cardiac remodelling.
Conclusions:
- RYGB and LSG are more effective than LAGB in reducing visceral adiposity.
- These procedures promote greater reverse left ventricular remodelling, including reductions in LVM and concentric remodelling.
Introduction:
Bariatric surgery is effective in reversing adverse cardiac remodelling in obesity. However, it is unclear whether the three commonly performed operations; Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB) are equal in their ability to reverse remodelling.
Methods:
Fifty-eight patients underwent CMR to assess left ventricular mass (LVM), LV mass:volume ratio (LVMVR) and LV eccentricity index (LVei) before and after bariatric surgery (26 RYGB, 22 LSG and 10 LAGB), including 46 with short-term (median 251-273 days) and 43 with longer-term (median 983-1027 days) follow-up. Abdominal visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) were also assessed.
Results:
All three procedures resulted in significant decreases in excess body weight (48-70%). Percentage change in VAT and EAT was significantly greater following RYGB and LSG compared to LAGB at both timepoints (VAT:RYGB -47% and -57%, LSG -47% and -54%, LAGB -31% and -25%; EAT:RYGB -13% and -14%, LSG -16% and -19%, LAGB -5% and -5%). Patients undergoing LAGB, whilst having reduced LVM (-1% and -4%), had a smaller decrease at both short (RYGB: -8%, p < 0.005; LSG: -11%, p < 0.0001) and long (RYGB: -12%, p = 0.009; LSG: -13%, p < 0.0001) term timepoints. There was a significant decrease in LVMVR at the long-term timepoint following both RYGB (-7%, p = 0.006) and LSG (-7%, p = 0.021), but not LAGB (-2%, p = 0.912). LVei appeared to decrease at the long-term timepoint in those undergoing RYGB (-3%, p = 0.063) and LSG (-4%, p = 0.015), but not in those undergoing LAGB (1%, p = 0.857). In all patients, the change in LVM correlated with change in VAT (r = 0.338, p = 0.0134), while the change in LVei correlated with change in EAT (r = 0.437, p = 0.001).
Conclusions:
RYGB and LSG appear to result in greater decreases in visceral adiposity, and greater reverse LV remodelling with larger reductions in LVM, concentric remodelling and pericardial restraint than LAGB.
