Abstract 12523: Ventricular Remodeling Post Bariatric Surgery: Sleeve Gastrectomy Vs. Gastric By-pass - A Prospective Study With 3-dimensional Strain
Aim: The aim of the study was to examine ventricular remodeling in a group of patients free of cardiac risk factors, before and 6 months post bariatric surgery with the new imaging modality of 3-dimensional strain and compare two surgical techniques: sleeve gastrectomy vs. gastric by-pass.
Methods: Fifty-two consecutive patients who were referred to the Bariatric Services of Imperial College NHS Trust were examined with conventional 2D and 3-dimensional strain echocardiography, prior and 6 months after bariatric surgery. They were all free from cardiac disease and risk factors for heart disease such as hypertension, hypercholesterolemia, diabetes and family history of heart disease.
Results: The study cohort comprised of 52 bariatric patients with mean age of 44.2 ± 8.7 years and body mass index (BMI) of 42.4 ± 4.6 g/m2. Eighteen patients (34.6%) underwent laparoscopic sleeve gastrectomy and 34 patients laparoscopic gastric by-pass. Twelve patients (23%) were excluded from the 3D strain assessment due to poor acoustic windows unsuitable for 3D. When patients were assessed with 3-dimensional speckle tracking, there was significant reverse remodeling post-bariatric surgery (LV-ejection fraction: pre-surgery: 59% ± 8% vs. post-surgery: 67% ± 7%, p≤0.001 and RV-ejection fraction: pre-surgery: 60% ± 9% vs. post-surgery: 68% ± 8.2%, p=0.0001). Furthermore, there was significant regression of mass post-surgery: LV-mass: pre-surgery: 111 gr ± 23.5 gr vs. post-surgery: 92.8 gr ± 15.5 gr, RV-mass: pre-surgery: 95.2 ± 19.8 vs. post-surgery: 67.3 ± 16.3, p≤0.001).
RV longitudinal strain significantly improved 6 months post bariatric surgery: Global RV strain: pre-surgery: 11.7 ± 4 vs. post-surgery: 17.52 ± 3.7, p≤0.001, Strain of RV free wall: pre-surgery: 11.8 ± 6 vs. post-surgery: 18.3 ± 4.4, p≤0.001.
Conclusion: Bariatric surgery has an important effect in reverse LV and RV ventricular remodelling and even further it improves substantially RV longitudinal strain. Sleeve gastrectomy and gastric by-pass have comparable effects with regards to post-operative ventricular remodeling.
- © 2013 by American Heart Association, Inc.