Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 1/2013

01-01-2013 | Clinical Research

Improvement in Cardiovascular Indices After Roux-en-Y Gastric Bypass or Sleeve Gastrectomy for Morbid Obesity

Authors: Alexander Kokkinos, Kleopatra Alexiadou, Christos Liaskos, Georgia Argyrakopoulou, Ioanna Balla, Nicholas Tentolouris, Ioannis Moyssakis, Nicholas Katsilambros, Irene Vafiadis, Andreas Alexandrou, Theodoros Diamantis

Published in: Obesity Surgery | Issue 1/2013

Login to get access

Abstract

Background

Morbidly obese patients display cardiac abnormalities which are partially reversed after weight loss. The aim of the present study was to assess the potential difference in cardiovascular disease indices between patients who underwent either gastric bypass surgery or sleeve gastrectomy.

Methods

Thirty-seven morbidly obese patients who underwent either Roux-en-Y gastric bypass (RYGB) (n = 14) or SG (n = 23) were examined before, 3 and 6 months after surgery. Indices of cardiac autonomic nervous system activity were evaluated, namely baroreflex sensitivity (BRS) and heart rate variability (HRV). A complete echocardiographic study was performed in a subgroup of 17 patients (RYGB 8, SG 9) preoperatively and 6 months after surgery, evaluating epicardial fat thickness, aortic distensibility, left ventricular (LV) Tei index, left atrium diameter, ejection fraction, and LV mass.

Results

All subjects experienced significant (p < 0.001) and similar weight loss independently of the type of operation. BRS and HRV indices improved significantly and to the same degree after surgery in both groups. In the echocardiographic study, all parameters improved significantly at 6 months in comparison with the baseline values. In addition, the RYGB group displayed significantly greater reduction in epicardial fat thickness (p = 0.007) and also tended to have a better LV performance as expressed by the lower values of the Tei index (p = 0.06) compared to the SG group 6 months after surgery.

Conclusions

Both RYGB and SG exert comparable effects on weight loss and improvement of cardiovascular parameters. RYGB displays a more beneficial influence on epicardial fat thickness and left ventricular performance than SG.
Literature
1.
Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.PubMedCrossRef
2.
Albu JB, Kovera AJ, Johnson JA. Fat distribution and health in obesity. Ann N Y Acad Sci. 2000;904:491–501.PubMedCrossRef
3.
Folsom AR, Kushi LH, Anderson KE, et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med. 2000;160:2117–28.PubMedCrossRef
4.
Rexrode KM, Carey VJ, Hennekens CH, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280:1843–8.PubMedCrossRef
5.
Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord. 2001;25:1047–56.PubMedCrossRef
6.
Peiris AN, Sothmann MS, Hoffmann RG, et al. Adiposity, fat distribution, and cardiovascular risk. Ann Intern Med. 1989;110:867–72.PubMed
7.
Logue J, Murray HM, Welsh P, et al. Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation. Heart. 2011;97:564–8.PubMedCrossRef
8.
Meigs JB, Wilson PW, Fox CS, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–12.PubMedCrossRef
9.
Yamaoka-Tojo M, Tojo T, Takahira N, et al. Elevated circulating levels of an incretin hormone, glucagon-like peptide-1, are associated with metabolic components in high-risk patients with cardiovascular disease. Cardiovasc Diabetol. 2010;9:17.PubMedCrossRef
10.
Kern PA, Ranganathan S, Li C, et al. Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab. 2001;280:E745–51.PubMed
11.
Iacobellis G, Ribaudo MC, Zappaterreno A, et al. Adapted changes in left ventricular structure and function in severe uncomplicated obesity. Obes Res. 2004;12:1616–21.PubMedCrossRef
12.
Iacobellis G, Ribaudo MC, Zappaterreno A, et al. Relationship of insulin sensitivity and left ventricular mass in uncomplicated obesity. Obes Res. 2003;11:518–24.PubMedCrossRef
13.
Iacobellis G, Ribaudo MC, Leto G, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002;10:767–73.PubMedCrossRef
14.
Willens HJ, Chakko SC, Lowery MH, et al. Tissue Doppler imaging of the right and left ventricle in severe obesity (body mass index >35 kg/m2). Am J Cardiol. 2004;94:1087–90.PubMedCrossRef
15.
Willens HJ, Chakko SC, Byers P, et al. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. Am J Cardiol. 2005;95:1521–4.PubMedCrossRef
16.
Rider OJ, Francis JM, Ali MK, et al. Beneficial cardiovascular effects of bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54:718–26.PubMedCrossRef
17.
Hsuan CF, Huang CK, Lin JW, et al. The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity (Silver Spring). 2010;18:1188–93.CrossRef
18.
Garza CA, Pellikka PA, Somers VK, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105:550–6.PubMedCrossRef
19.
Malavazos AE, Corsi MM, Ermetici F, et al. Proinflammatory cytokines and cardiac abnormalities in uncomplicated obesity: relationship with abdominal fat deposition. Nutr Metab Cardiovasc Dis. 2007;17:294–302.PubMedCrossRef
20.
Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res. 2002;10:489–98.PubMedCrossRef
21.
Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003;11:304–10.PubMedCrossRef
22.
Malavazos AE, Ermetici F, Coman, et al. Influence of epicardial adipose tissue and adipocytokine levels on cardiac abnormalities in visceral obesity. Int J Cardiol. 2007;121:132–4.PubMedCrossRef
23.
Iacobellis G, Ribaudo MC, Zappaterreno A, et al. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol. 2004;94:1084–7.PubMedCrossRef
24.
Iacobellis G, Leonetti F, Singh N, et al. Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects. Int J Cardiol. 2007;115:272–3.PubMedCrossRef
25.
Maher V, O'Dowd M, Carey M, et al. Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors. Int J Obes (Lond). 2009;33:136–43.CrossRef
26.
Wildman RP, Farhat GN, Patel AS, et al. Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension. 2005;45:187–92.PubMedCrossRef
27.
Natale F, Tedesco MA, Mocerino R, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr. 2009;10:549–55.PubMedCrossRef
28.
Rider OJ, Tayal U, Francis JM, et al. The effect of obesity and weight loss on aortic pulse wave velocity as assessed by magnetic resonance imaging. Obesity (Silver Spring). 2010;18:2311–6.CrossRef
29.
Quilliot D, Böhme P, Zannad F, et al. Sympathetic-leptin relationship in obesity: effect of weight loss. Metabolism. 2008;57:555–62.PubMedCrossRef
30.
Skrapari I, Tentolouris N, Katsilambros N. Baroreflex function: determinants in healthy subjects and disturbances in diabetes, obesity and metabolic syndrome. Curr Diabetes Rev. 2006;2:329–38.PubMedCrossRef
31.
Ashida T, Ono C, Sugiyama T. Effects of short-term hypocaloric diet on sympatho-vagal interaction assessed by spectral analysis of heart rate and blood pressure variability during stress tests in obese hypertensive patients. Hypertens Res. 2007;30:1199–203.PubMedCrossRef
32.
le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.PubMedCrossRef
33.
le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243:108–14.PubMedCrossRef
34.
Pournaras DJ, Osborne A, Hawkins SC, et al. The gut hormone response following Roux-en-Y gastric bypass: cross-sectional and prospective study. Obes Surg. 2010;20:56–60.PubMedCrossRef
35.
Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRef
36.
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.PubMedCrossRef
37.
Skrapari I, Tentolouris N, Perrea D, et al. Baroreflex sensitivity in obesity: relationship with cardiac autonomic nervous system activity. Obesity (Silver Spring). 2007;15:1685–93.CrossRef
38.
Ziegler D, Zentai CP, Perz S, et al. Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg Cohort Study. Diabetes Care. 2008;31:556–61.PubMedCrossRef
39.
Stefanadis C, Stratos C, Boudoulas H, et al. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with arterial disease. Eur Heart J. 1990;11:990–6.PubMed
40.
Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol. 1995;26:135–6.PubMed
41.
Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–8.PubMedCrossRef
42.
Benedix F, Westphal S, Patschke R, et al. Weight loss and changes in salivary ghrelin and adiponectin: comparison between sleeve gastrectomy and Roux-en-Y gastric bypass and gastric banding. Obes Surg. 2011;21:616–24.PubMedCrossRef
43.
Woelnerhanssen B, Peterli R, Steinert RE, et al. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy-a prospective randomized trial. Surg Obes Relat Dis. 2011;7:561–8.PubMedCrossRef
44.
Freire RH, Borges MC, Alvarez-Leite, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28:53–8.PubMedCrossRef
45.
Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy—further procedure? Obes Facts. 2011;4 Suppl 1:42–6.PubMed
46.
Alvarez GE, Davy BM, Ballard TP, et al. Weight loss increases cardiovagal baroreflex function in obese young and older men. Am J Physiol Endocrinol Metab. 2005;289:E665–9.PubMedCrossRef
47.
Straznicky NE, Lambert EA, Lambert GW, et al. Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J Clin Endocrinol Metab. 2005;90:5998–6005.PubMedCrossRef
48.
Nault I, Nadreau E, Paquet C, et al. Impact of bariatric surgery-induced weight loss on heart rate variability. Metabolism. 2007;56:1425–30.PubMedCrossRef
49.
Alam I, Lewis MJ, Lewis KE, et al. Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci. 2009;151:168–73.PubMedCrossRef
50.
Garza CA, Pellikka PA, Somers VK, et al. Major weight loss prevents long-term left atrial enlargement in patients with morbid and extreme obesity. Eur J Echocardiogr. 2008;9:587–93.PubMedCrossRef
51.
Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normal and dilated cardiomyopathy. J Cardiol. 1995;26:357–66.PubMed
52.
Arnlöv J, Ingelsson E, Risérus U, et al. Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men. Eur Heart J. 2004;25:2220–5.PubMedCrossRef
53.
Mishra RK, Kizer JR, Palmieri V, et al. Utility of the myocardial performance index in a population with high prevalences of obesity, diabetes, and hypertension: the strong heart study. Echocardiography. 2007;24:340–7.PubMedCrossRef
54.
Fields AV, Patterson B, Karnik AA, et al. Glucagon-like peptide-1 and myocardial protection: more than glycemic control. Clin Cardiol. 2009;32:236–43.PubMedCrossRef
55.
Vendrell J, El Bekay R, Peral B, et al. Study of the potential association of adipose tissue GLP-1 receptor with obesity and insulin resistance. Endocrinology. 2011;152:4072–9.PubMedCrossRef
56.
Poornima I, Brown SB, Bhashyam S, et al. Chronic glucagon-like peptide-1 infusion sustains left ventricular systolic function and prolongs survival in the spontaneously hypertensive, heart failure-prone rat. Circ Heart Fail. 2008;1:153–60.PubMedCrossRef
57.
Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25:439–47.PubMedCrossRef
58.
Valezi AC, Machado VH. Morphofunctional evaluation of the heart of obese patients before and after bariatric surgery. Obes Surg. 2011;21:1693–7.PubMedCrossRef
Metadata
Title
Improvement in Cardiovascular Indices After Roux-en-Y Gastric Bypass or Sleeve Gastrectomy for Morbid Obesity
Authors
Alexander Kokkinos
Kleopatra Alexiadou
Christos Liaskos
Georgia Argyrakopoulou
Ioanna Balla
Nicholas Tentolouris
Ioannis Moyssakis
Nicholas Katsilambros
Irene Vafiadis
Andreas Alexandrou
Theodoros Diamantis
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 1/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0743-8

Other articles of this Issue 1/2013

Obesity Surgery 1/2013 Go to the issue

Clinical Research

Predictors for Remission of Major Components of the Metabolic Syndrome After Biliopancreatic Diversion with Duodenal Switch (BPDDS)

Letter to the Editor

Letter to “Mapping of Ghrelin Gene Expression and Cell Distribution in the Stomach of Morbidly Obese Patients—a Possible Guide for Efficient Sleeve Gastrectomy Construction” Obesity Surgery (2012) 22:617–622. doi:10.1007/s11695-011-0585-9

Clinical Research

Roux-en Y Gastric Bypass Surgery Reduces Hedonic Hunger and Improves Dietary Habits in Severely Obese Subjects

Clinical Research

Hematological Variables and Iron Status in Abdominoplasty After Bariatric Surgery

Letter to the Editor

Letter to “Mapping of Ghrelin Gene Expression and Cell Distribution in the Stomach of Morbidly Obese Patients—a Possible Guide for Efficient Sleeve Gastrectomy Construction”—Authors’ Reply

Clinical Research

Examining the Binge Eating Scale in Screening for Binge Eating Disorder in Bariatric Surgery Candidates