在减肥手术后,与左心室功能障碍相关的术前风险因素
Lisa M D Grymyr1,2, Gunnar Mellgren3,4, Adrian McCann5
1Department of Heart Disease, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.
Scientific reports
|January 25, 2024
概括
严重肥胖的患者可能在减肥手术后出现持续的左心室 (LV) 功能障碍. 术前心声学和像hsCRP这样的炎症标志物可以识别那些在手术后面面临高风险的LV机制受损的患者.
科学领域:
- 心脏病学 心脏病学
- 肥胖医学 肥胖医学
- 腹部外科 腹部外科
背景情况:
- 严重的肥胖与左心室 (LV) 功能障碍有关.
- 减肥手术可以改善肥胖症,但可能不会在所有患者中完全恢复心脏功能.
- 在手术后确定患有持续性LV功能障碍的患者至关重要.
研究的目的:
- 评估手术前心声学和炎症性蛋白质水平是否可以识别患有严重肥胖症的患者,在减肥手术后患有LV功能障碍的高风险.
- 评估Roux-en-Y胃绕道对LV机制和炎症标志物的影响.
主要方法:
- 对75名患有严重肥胖症的患者进行前性评估,这些患者正在接受Roux-en-Y胃绕道术.
- 术前和1年术后评估LV力学 (中壁缩短[MWS],全球纵向应变[GLS]) 通过心声学.
- 在手术前测量炎症蛋白质:高灵敏度C反应蛋白 (hsCRP),血清粉样蛋白A (SAA) 和calprotectin.
主要成果:
- 腹部手术改善了BMI,GLS,并降低了hsCRP,calprotectin和SAA.
- 在1年的随访中,MWS保持不变,有35%的患者在1年的随访中显示MWS受损.
- 一个手术前的风险指数 (性别,高血压,喷射分数[EF],hsCRP/SAA) 预测了低1年MWS的高准确度 (AUC~0.80).
结论:
- 严重肥胖的患者中有很大一部分在减肥手术后1年经历了持续的LV中壁力学损伤.
- 术前评估包括心声回声 (EF) 和炎症标志物 (hsCRP,SAA) 可以识别高风险个体.
- 女性,高血压患者,以及炎症标志物升高和EF降低的患者,在手术后面面临较高的LV力学损伤风险.
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