Top

Published in:

01-10-2020 | Obesity | Original Contributions

Improvements in Heart Rate Variability in Women with Obesity: Short-term Effects of Sleeve Gastrectomy

Authors: Paulina Ibacache, Paulina Cárcamo, Claudia Miranda, Andrés Bottinelli, Jaime Guzmán, Elena Martínez-Rosales, Enrique G. Artero, Marcelo Cano-Cappellacci

Published in: Obesity Surgery | Issue 10/2020

Abstract

Purpose

Obesity has been associated with reduced vagal function and increased sympathetic activity. Cardiac autonomic dysfunction has emerged as a major risk factor in the development of cardiovascular disease. Cardiac autonomic function (CAF) can be assessed by heart rate variability (HRV), an independent predictor of mortality based on changes in time intervals between adjacent heartbeats (RR). Bariatric surgery is considered the most effective treatment for obesity and its comorbidities, with sleeve gastrectomy (SG) being the most frequent bariatric procedure. There are few studies on HRV changes in women with obesity after SG. The aim of this study was to evaluate the short-term impact of SG on CAF and its relationship with weight loss.

Materials and Methods

An observational cohort study was conducted. Twenty-three female patients were assessed before SG and at 1 and 3 months after surgery. CAF was evaluated by analyzing HRV from 5-min records of RR intervals while the subject was supine. HRV was analyzed in time and frequency domains and with a nonlinear method.

Results

Patients (36.0 ± 11.1 years old, BMI 35.1 ± 3.4 kg/m²) presented higher HRV values, on average, in all domains both at 1 and 3 months after SG (p < 0.05). In addition, all anthropometric parameters improved (p < 0.001) although there was no relationship between HRV improvements and anthropometric changes.

Conclusion

SG seems to be effective at reducing excess weight and improving HRV at the short term, and these changes are detectable as early as the first month after surgery. HRV assessment appears as a promising low-cost tool that deserves further research.

World Health Organization. Obesity and overweight. [Internet]. [cited 2020 Feb 12]. Available from: www.who.int/mediacentre/factsheets/fs311/en/

Inoue Y, Qin B, Poti J, et al. Epidemiology of obesity in adults: latest trends. Curr Obes Rep. 2018;7(4):276–88. https://doi.org/10.1007/s13679-018-0317-8.CrossRefPubMed

Garcia M, Mulvagh SL, Merz CN, et al. Cardiovascular disease in women: clinical perspectives. Circ Res. 2016;118(8):1273–93. https://doi.org/10.1161/CIRCRESAHA.116.307547.CrossRefPubMedPubMedCentral

Williams EP, Mesidor M, Winters K, et al. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep. 2015;4(3):363–70. https://doi.org/10.1007/s13679-015-0169-4.CrossRefPubMed

Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: a risk factor or a risk marker? Curr Atheroscler Rep. 2016;18(5):21. https://doi.org/10.1007/s11883-016-0575-4.CrossRefPubMed

Pareek M, Bhatt DL, Schiavon CA, et al. Metabolic surgery for hypertension in patients with obesity. Circ Res. 2019;124(7):1009–24. https://doi.org/10.1161/CIRCRESAHA.118.313320.CrossRefPubMed

GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. https://doi.org/10.1056/NEJMoa1614362.CrossRef

Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and prognosis—the obesity paradox updated. Prog Cardiovasc Dis. 2016;58(5):537–47. https://doi.org/10.1016/j.pcad.2016.01.008.CrossRefPubMed

Alpert M, Omran J, Mehra A, et al. Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis. 2014;56(4):391–400. https://doi.org/10.1016/j.pcad.2013.09.003.CrossRefPubMed

10.

Wijngaarden MA, Pijl H, van Dijk KW, et al. Obesity is associated with an altered autonomic nervous system response to nutrient restriction. Clin Endocrinol. 2013;79(5):648–51. https://doi.org/10.1111/cen.12100.CrossRef

11.

Straznicky NE, Lambert GW, Lambert EA. Neuroadrenergic dysfunction in obesity: an overview of the effects of weight loss. Curr Opin Lipidol. 2010;21(1):21–30. https://doi.org/10.1097/MOL.0b013e3283329c62.CrossRefPubMed

12.

Guarino D, Nannipieri M, Iervasi G, et al. The role of the autonomic nervous system in the pathophysiology of obesity. Front Psychol. 2017;8:665. https://doi.org/10.3389/fphys.2017.00665.CrossRef

13.

Triggiani AI, Valenzano A, Ciliberti MA, et al. Heart rate variability is reduced in underweight and overweight healthy adult women. Clin Physiol Funct Imaging. 2017;37(2):162–7. https://doi.org/10.1111/cpf.12281.CrossRefPubMed

14.

Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Front Psychol. 2014;5:1040. https://doi.org/10.3389/fpsyg.2014.01040.CrossRefPubMedPubMedCentral

15.

Xhyheri B, Manfrini O, Mazzolini M, et al. Heart rate variability today. Prog Cardiovasc Dis. 2012;55(3):321–31. https://doi.org/10.1016/j.pcad.2012.09.001.CrossRefPubMed

16.

Vigo DE, Siri LN, Cardinali DP. Heart rate variability: a tool to explore autonomic nervous system activity in health and disease. In: Gargiulo P, Mesones Arroyo H, editors. Psychiatry and neuroscience update. Cham: Springer; 2019. p. 113–26.CrossRef

17.

Rahman S, Habel M, Contrada RJ. Poincaré plot indices as measures of sympathetic cardiac regulation: responses to psychological stress and associations with pre-ejection period. Int J Psychophysiol. 2018;133:79–90. https://doi.org/10.1016/j.ijpsycho.2018.08.005.CrossRefPubMed

18.

Kubičková A, Kozumplík J, Nováková Z, et al. Heart rate variability analysed by Poincaré plot in patients with metabolic syndrome. J Electrocardiol. 2016;49(1):23–8. https://doi.org/10.1016/j.jelectrocard.2015.11.004.CrossRefPubMed

19.

Task Force of the European Society of Cardiology and the North American Society of Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation and clinical use. Eur Heart J. 1996;17(3):354–81.CrossRef

20.

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(3):556–61. https://doi.org/10.2337/dc07-1615.CrossRefPubMed

21.

Koko KR, McCauley BD, Gaughan JP, et al. Spectral analysis of heart rate variability predicts mortality and instability from vascular injury. J Surg Res. 2018;224:64–71. https://doi.org/10.1016/j.jss.2017.11.029.CrossRefPubMed

22.

Sessa F, Anna V, Messina G, et al. Heart rate variability as predictive factor for sudden cardiac death. Aging. 2018;10(2):166–77. https://doi.org/10.18632/aging.101386.CrossRefPubMedPubMedCentral

23.

Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health. 2017;5:258. https://doi.org/10.3389/fpubh.2017.00258.CrossRefPubMedPubMedCentral

24.

Wulsin LR, Horn PS, Perry JL, et al. Autonomic imbalance as a predictor of metabolic risks, cardiovascular disease, diabetes, and mortality. J Clin Endocrinol Metab. 2015;100(6):2443–8. https://doi.org/10.1210/jc.2015-1748.CrossRefPubMed

25.

Rajendra Acharya U, Paul Joseph K, Kannathal N, et al. Heart rate variability: a review. Med Biol Eng Comput. 2006;44(12):1031–51. https://doi.org/10.1007/s11517-006-0119-0.CrossRefPubMed

26.

Sabbag A, Sidi Y, Kivity S, et al. Obesity and exercise-induced ectopic ventricular arrhythmias in apparently healthy middle aged adults. Eur J Prev Cardiol. 2016;23(5):511–7. https://doi.org/10.1177/2047487315591442.CrossRefPubMed

27.

Adabag S, Huxley RR, Lopez FL, et al. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Heart. 2015;101(3):215–21. https://doi.org/10.1136/heartjnl-2014-306238.CrossRefPubMed

28.

Chiuve SE, Sun Q, Sandhu RK, et al. Adiposity throughout adulthood and risk of sudden cardiac death in women. JACC Clin Electrophysiol. 2015;1(6):520–8. https://doi.org/10.1016/j.jacep.2015.07.011.CrossRefPubMedPubMedCentral

29.

Montesi L, El Ghoch M, Brodosi L, et al. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes. 2016;9:37–46. https://doi.org/10.2147/DMSO.S89836.CrossRefPubMedPubMedCentral

30.

Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94. https://doi.org/10.1007/s11695-018-3450-2.CrossRefPubMed

31.

Welbourn R, Pournaras DJ, Dixon J, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the second IFSO Global Registry Report 2013–2015. Obes Surg. 2018;28(2):313–22. https://doi.org/10.1007/s11695-017-2845-9.CrossRefPubMed

32.

Jakobsen GS, Småstuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA. 2018;319(3):291–301. https://doi.org/10.1001/jama.2017.21055.CrossRefPubMedPubMedCentral

33.

Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14(3):160–9. https://doi.org/10.1038/nrgastro.2016.170.CrossRefPubMed

34.

Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58. https://doi.org/10.1007/s11695-014-1460-2.CrossRefPubMed

35.

Bower G, Toma T, Harling L, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25(12):2280–9. https://doi.org/10.1007/s11695-015-1691-x.CrossRefPubMed

36.

Kokkinos A, Alexiadou K, Liaskos C, et al. Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg. 2013;23(1):31–8. https://doi.org/10.1007/s11695-012-0743-8.CrossRefPubMed

37.

Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110(4):600–7. https://doi.org/10.1016/j.jada.2009.12.022.CrossRefPubMed

38.

Redberg RF, Benjamin EJ, Bittner V, et al. AHA/ACCF 2009 performance measures for primary prevention of cardiovascular disease in adults. Circulation. 2009;120(13):1296–336. https://doi.org/10.1161/CIRCULATIONAHA.109.192617.CrossRefPubMed

39.

Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606. https://doi.org/10.1016/j.soard.2015.02.003.CrossRefPubMed

40.

Barbosa MP, da Silva NT, de Azevedo FM, et al. Comparison of Polar® RS800G3™ heart rate monitor with Polar® S810i™ and electrocardiogram to obtain the series of RR intervals and analysis of heart rate variability at rest. Clin Physiol Funct Imaging. 2016;36(2):112–7. https://doi.org/10.1111/cpf.12203.CrossRefPubMed

41.

Hernando D, Garatachea N, Almeida R, et al. Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise. J Strength Cond Res. 2018;32(3):716–25. https://doi.org/10.1519/jsc.0000000000001662.CrossRefPubMed

42.

Williams DP, Jarczok MN, Ellis RJ, et al. Two-week test-retest reliability of the Polar® RS800CX™ to record heart rate variability. Clin Physiol Funct Imaging. 2017;37(6):776–81. https://doi.org/10.1111/cpf.12321.CrossRefPubMed

43.

Gisselman AS, D’Amico M, Smoliga JM. Optimizing inter-session reliability of heart rate variability – the effects of artefact correction and breathing type. J Strength Cond Res. 2017:1. https://doi.org/10.1519/JSC.0000000000002258.

44.

Tarvainen MP, Niskanen JP, Lipponen JA, et al. Kubios HRV—heart rate variability analysis software. Comput Methods Prog Biomed. 2014;113(1):210–20. https://doi.org/10.1016/j.cmpb.2013.07.024.CrossRef

45.

Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Semin Nephrol. 2013;33(1):75–89. https://doi.org/10.1016/j.semnephrol.2012.12.004.CrossRefPubMed

46.

Casellini CM, Parson HK, Hodges K, et al. Bariatric surgery restores cardiac and sudomotor autonomic C-fiber dysfunction towards normal in obese subjects with type 2 diabetes. PLoS One. 2016;11(5):e0154211. https://doi.org/10.1371/journal.pone.0154211.CrossRefPubMedPubMedCentral

47.

Wu JM, Yu HJ, Lai HS, et al. Improvement of heart rate variability after decreased insulin resistance after sleeve gastrectomy for morbidly obesity patients. Surg Obes Relat Dis. 2015;11(3):557–63. https://doi.org/10.1016/j.soard.2014.09.011.CrossRefPubMed

48.

Poirier P, Hernandez TL, Weil KM, et al. Impact of diet-induced weight loss on the cardiac autonomic nervous system in severe obesity. Obes Res. 2003;11(9):1040–7. https://doi.org/10.1038/oby.2003.143.CrossRefPubMed

49.

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(11):5998–6005. https://doi.org/10.1210/jc.2005-0961.CrossRefPubMed

50.

Rosenbaum M, Hirsch J, Murphy E, et al. Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. Am J Clin Nutr. 2000;71(6):1421–32. https://doi.org/10.1093/ajcn/71.6.1421.CrossRefPubMed

51.

Bettini S, Bordigato E, Fabris R, et al. Modifications of resting energy expenditure after sleeve gastrectomy. Obes Surg. 2018;28(8):2481–6. https://doi.org/10.1007/s11695-018-3190-3.CrossRefPubMed

52.

Olshansky B, Sabbah HN, Hauptman PJ, et al. Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy. Circulation. 2008;118(8):863–71. https://doi.org/10.1161/CIRCULATIONAHA.107.760405.CrossRefPubMed

53.

Guiraud T, Labrunee M, Gaucher-Cazalis K, et al. High-intensity interval exercise improves vagal tone and decreases arrhythmias in chronic heart failure. Med Sci Sports Exerc. 2013;45(10):1861–7. https://doi.org/10.1249/MSS.0b013e3182967559.CrossRefPubMed

54.

Dimova R, Tankova T, Chakarova N, et al. Cardiovascular autonomic tone relation to metabolic parameters and hsCRP in normoglycemia and prediabetes. Diabetes Res Clin Pract. 2015;109(2):262–70. https://doi.org/10.1016/j.diabres.2015.05.024.CrossRefPubMed

55.

Leung M, Xie M, Durmush E, et al. Weight loss with sleeve gastrectomy in obese type 2 diabetes mellitus: impact on cardiac function. Obes Surg. 2016;26(2):321–6. https://doi.org/10.1007/s11695-015-1748-x.CrossRefPubMed

56.

Cavarretta E, Casella G, Calì B, et al. Cardiac remodeling in obese patients after laparoscopic sleeve gastrectomy. World J Surg. 2013;37(3):565–72. https://doi.org/10.1007/s00268-012-1874-8.CrossRefPubMed

57.

Geronikolou SA, Albanopoulos K, Chrousos G, et al. Evaluating the homeostasis assessment model insulin resistance and the cardiac autonomic system in bariatric surgery patients: a meta-analysis. Adv Exp Med Biol. 2017;988:249–59. https://doi.org/10.1007/978-3-319-56246-9_20.CrossRefPubMed

58.

Castello V, Simões RP, Bassi D, et al. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg. 2011;21(11):1739–49. https://doi.org/10.1007/s11695-010-0319-4.CrossRefPubMed

59.

Bobbioni-Harsch E, Sztajzel J, Barthassat V, et al. Independent evolution of heart autonomic function and insulin sensitivity during weight loss. Obesity. 2009;17(2):247–53. https://doi.org/10.1038/oby.2008.532.CrossRefPubMed

60.

Koenig J, Thayer JF. Sex differences in healthy human heart rate variability: a meta-analysis. Neurosci Biobehav Rev. 2016;64:288–310. https://doi.org/10.1016/j.neubiorev.2016.03.007.CrossRefPubMed

61.

Lodder AF, Kamath MV, Armstrong D, et al. Bariatric surgery and its effects on heart rate variability. In: Kamath MV, Watanabe MA, Upton ARM, editors. Heart Rate variability (HRV) signal analysis. Clinical Applications. Boca Raton: CRC Press; 2013. p. 279–302.

Title: Improvements in Heart Rate Variability in Women with Obesity: Short-term Effects of Sleeve Gastrectomy
Authors: Paulina Ibacache
Paulina Cárcamo
Claudia Miranda
Andrés Bottinelli
Jaime Guzmán
Elena Martínez-Rosales
Enrique G. Artero
Marcelo Cano-Cappellacci
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Obesity
Obesity
Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 10/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04721-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improvements in Heart Rate Variability in Women with Obesity: Short-term Effects of Sleeve Gastrectomy

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2020

Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case Report

Do Endoscopic Bariatric Procedures Improve Postprocedural Quality of Life and Mental Health? A Systematic Review and Meta-analysis

Acute and Chronic Impact of Biliopancreatic Diversion with Duodenal Switch Surgery on Plasma Lipoprotein(a) Levels in Patients with Severe Obesity

Are Patients Suffering from Severe Obesity Getting a Raw Deal During COVID-19 Pandemic?

Glucose-Lipid Metabolism in Obesity with Elevated Prolactin Levels and Alteration of Prolactin Levels After Laparoscopic Sleeve Gastrectomy

Preventing Nausea and Vomiting After Bariatric Surgery: Is the Apfel Risk Prediction Score Enough to Guide Prophylaxis?