Left ventricular myocardial oxygen demand and subclinical dysfunction in patients with severe obesity referred for bariatric surgery.

Abstract

BACKGROUND AND AIMS:

Increased myocardial oxygen (O2) demand carries higher cardiovascular risk in hypertension. We hypothesized that myocardial O2 demand is increased in severe obesity and linked to early left ventricular (LV) dysfunction.

METHODS AND RESULTS:

Baseline data from 106 severely obese subjects referred for gastric bypass surgery (42 ± 11 years, 74% women, body mass index [BMI] 41.9 ± 4.8 kg/m2, 32% with hypertension) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV systolic function was assessed by biplane ejection fraction (EF), midwall shortening (MWS) and endocardial global longitudinal strain (GLS), and LV diastolic function by mitral annular early diastolic velocity (e'). Myocardial O2 demand was estimated from the LV mass-wall stress-heart rate product (high if > 1.62 × 106/2.29 × 106 g kdyne/cm2 bpm in women/men). High myocardial O2 demand was found in 33% and associated with higher BMI and high prevalence of low GLS (65%) and low MWS (63%) despite normal EF. In ROC analyses, higher myocardial O2 demand discriminated between patients with low vs. normal MWS and GLS (area under curve 0.71 and 0.63, p < 0.05). In successive multiple regression analyses, higher myocardial O2 demand was associated with lower LV MWS, GLS and average e', respectively, independent of age, gender, BMI, pulse pressure, diabetes mellitus, and EF (all p < 0.05).

CONCLUSION:

In obese patients without known heart disease and with normal EF referred for bariatric surgery, high myocardial O2 demand is associated with lower myocardial function whether assessed by GLS or MWS independent of confounders. CLINICALTRIALS.

GOV IDENTIFIER:

NCT01533142.

• Authors: Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Johannes J Hjertaas, Knut Matre, Dana Cramariuc
• Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD (Nutr Metab Cardiovasc Dis) Vol. 31 Issue 2 Pg. 666-674 (02 08 2021) ISSN: 1590-3729 [Electronic] Netherlands
• PMID: 33257189 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Topics

• Adult
• Bariatric Surgery
• Cross-Sectional Studies
• Echocardiography
• Female
• Humans
• Male
• Middle Aged
• Myocardium (metabolism)
• Norway
• Obesity (complications, diagnosis, surgery)
• Oxygen Consumption
• Prospective Studies
• Referral and Consultation
• Severity of Illness Index
• Ventricular Dysfunction, Left (diagnostic imaging, etiology, metabolism, physiopathology)
• Ventricular Function, Left