Abstract 6219: Weight Loss After Gastric Bypass Surgery Is Associated With Increased Incidence Of Tricuspid Regurgitation
Weight loss achieved with anorexigenic drugs has been associated with valvular abnormalities. It is unknown whether weight loss occurring through other means might also affect the heart valves. We prospectively assessed the baseline prevalence and new incidence of valvular regurgitation in a large group of patients before and after gastric bypass surgery (GBS). 1156 severely obese patients were enrolled in a prospective study evaluating the cardiovascular effects of GBS (n=423) or nonsurgical therapy (control; n=733). 723 patients had echocardiograms at baseline and 487 patients had follow up echoes at 2 years. Valvular regurgitation was graded as 0–4 for all the valves based on color and spectral Doppler during each visit. The prevalence of valvular regurgitation was the same in GBS vs. controls at baseline. During visit 1, 3% had mitral regurgitation (MR), 4% had aortic insufficiency (AI), 4.6% had tricuspid regurgitation (TR) and 1% had pulmonary insufficiency (PI). At 2 year follow up, 13% had TR, 6 and 7% had MR and AI respectively. At the follow up visit, patients in the GBS group lost 44 kg as compared to 1 kg in controls. Weight loss was associated with lower systolic BP, marked reduction in sleep apnea, decreased heart rate (HR) and improved insulin levels and sensitivity. Despite these beneficial changes, twice as many in the GBS group had TR than in the control group (68% vs. 30% respectively, p <0.05). Of all the patients that had TR at visit 2, only 25% had TR at baseline. By univariate analysis, weight loss (p <0.0001), lower HR (p <0.005) and lower insulin levels (p <0.0002) were associated with development of TR. By multivariate analysis (adjusting for change in weight, HR, SBP, insulin levels and sleep apnea), only weight loss (p <0.005) and change in HR (p <0.015) were associated with TR. Marked weight loss after GBS is associated with an increased frequency of valvular regurgitation. This was mainly due to a higher incidence of TR. Changes in geometry of the right ventricle and/or tricuspid annulus may explain the alterations in tricuspid valve function. Findings from our study suggest that hemodynamic and metabolic factors that change during weight loss may affect the valve structure and function.