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Bariatrik Cerrahi ile Kilo Kaybının Kardiyak Fonksiyonlara Etkisinin Ekokardiyografi İle Değerlendirilmesi

Year 2016, Volume: 7 Issue: 27, 0 - 0, 18.06.2016
https://doi.org/10.17944/mkutfd.66764

Abstract

Amaç: Bariatrik cerrahi tedavi hızlı bir şekilde kilo kaybında çok etkili olmaktadır. Bu çalışmamızda obezite cerrahisi öncesi ve sonrasında biyokimyasal ve ekokardiyografik olarak kardiyak fonksiyonları inceledik.

Gereç ve Yöntem: Çalışmamıza prospektif olarak Genel cerrahi polikliniğinde bariatrik cerrahiye (laparoskopik sleeve gastrektomi) uygun olarak değerlendirilen, 23-55 yaş arası, morbit obez ( VKİ 47.8 ± 7.3 kg/m2 ) olan 30 (22 kadın ve 8 erkek ) hasta alınmıştır. Hastaların fizik muayene ve biyokimyasal testleri yapıldı. Bariatrik cerrahi öncesi ve 6 ay sonrası konvensiyonal ve doku doppler ekokardiyografi parametreleri, sol ve sağ ventrikül fonksiyonları, miyokard performans indeksleri (MPI), sol ve sağ atriyal volüm endeksleri ölçüldü.

Bulgular: VKİ cerrahi öncesi 47.8 ±7.3 kg/m2 iken 6 ay sonunda 34.1±7.1 kg/m2 ölçüldü (p<0.001).  Kalp hızı (p= 0.020) ve sistolik (p = 0.003) ve diyastolik kan basıncı (p = 0.009) ve plasma açlık glukoz (p<0.001) değerleri iki grup arasında anlamlı düşük bulundu. Sol ventrikül diyastol sonu çapı, sol ventrikül kitlesi, Triküspit E/A oranı ve sol atrium volüm indeksi anlamlı olarak farklı idi (sırasıyla p= 0.026, p= 0.010, p<0.001, p= 0.006 ). Sol ventrikül septal MPI (0.44±0.06 ;    0.40±0.06, p=0.05) ve sağ ventrikül MPI anlamlı şekilde düştüğü gözlendi (0.43±0.08       ; 0.35±0.05, p<0.001).

 

Sonuç: Kilo kaybının morbid obez hastalarda kardiyak fonksiyonları iyileştirdiğini düşündürmektedir. Bulgularımız hastaların sistolik ve diyastolik fonsiyonlarında olumsuz değişme olmadığını, ayrıca  myokard performans indeksinin iyileştiği sonucunu ortaya koymuştur.

 

References

  • REFERANSLAR
  • Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systemic analysis of population health data. Lancet 2006;370:109-110.
  • Wolf HK, Tuomilehto J, Kuulasmaa K, Domarkiene S, Cepaitis Z, Molarius A, et al. Blood pressure levels in the 41 populations of the WHO MONICA project. J Hum Hypertens 1997;11:733-742.
  • Cassano PA, Segal MR, Vokonas PS, Weiss ST. Body fat distribution, blood pressure, and hypertension: a prospective cohort study of men in the normative aging study. Ann Epidemiol 1990;1:33-48.
  • Kastarinen MJ, Nissinen AM, Vartiainen EA. Blood pressure levels and obesity trends in hypertensive and normotensive Finnish population from 1982 to 1997. J Hypertens 2000;18:255-262.
  • Calle EE Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body –mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341:1097-1105.
  • Shimizu H, Timratana P, Schauer PR, Rogula T. Review of Metabolic Surgery for Type 2 Diabetes in Patients with a BMI < 35 kg/m(2). J Obes. 2012; 2012:147256.
  • Peterson LR, Waggoner AD, Schechtman KB Meyer T, Gropler RJ, Barzilai B, Dávila-Román VG. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 2004;43:1399–1404.
  • Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561–1566.
  • Hsuan CF, Huang CK, Lin JW, Lin LC, Lee TL. The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity 2010;18:1188-1193.
  • Lavie CJ, Milani RV, Ventura HO, Cardenas GA, Mehra MR, Messerli FH. Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol 2007;100:1460–1464.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. The committee on M-mode standardization of the American Society of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072-1083.
  • Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450–458.
  • Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski GR, Ventura HO, Oigman W, Frohlich ED, Dunn FG. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med 1983;99:757–761.
  • Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225–236.
  • Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925–1932.
  • Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death: Increased ventricular ectoypy in cardiopathy of obesity. Arch Intern Med 1987; 147:1725-1728.
  • Bryan Ristow, John Rabkin, And Ernest Haeusslein. Improvement in Dilated Cardiomyopathy After Bariatric Surgery. Cardiac Fail 2008;14:198-202.
  • Howard J. Willens, Patricia Byers, Julio A. Chirinos, Eugenio Labrador, Joshua M. Hare,and Eduardo de Marchena. Effects of Weight Loss After Bariatric Surgery on Epicardial Fat Measured Using Echocardiography. Am J Cardiol 2007;99:1242–1245.
  • Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes. Obes Surg. 2015 Sep 2. DOI 10.1007/s11695-015-1866-5
  • Zarich SW, Kowalchuk GJ, McGuire MP, Benotti PN, Mascioli EA, Nesto RW. Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol 1991;68:377-381.
  • Chakko S, Mayor M, Allison MD, Kessler KM, Materson BJ, Myerburg RJ. Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity. Am J Cardiol 1991;68:95-98.
  • Ippisch HM1, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, Glascock BJ, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008 ;51(14):1342-1348.
  • Hurrel DG, Nishimura RA, Ilstrup DM, Appleton CP: Utelity of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 1997;30:459-467
  • Moller JE, Poulsen SH, Egstrup K: Effect of preload alterations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiographay 1999;12:1065-1072
  • Sokmen A, Sokmen G, Acar G, Akcay A, Koroglu S, Koleoglu M, et al. The impact of isolated obesity on right ventricular function in young adults. Arq Bras Cardiol 2013;101:160-168.
  • Chahal H, McClelland RL, Tandri H, Jain A, Turkbey EB, Hundley WG. Obesity and right ventricular structure and functions: the MESA-right ventricle study. Chest 2012;141:388-395.
  • de Divitiis O, Fazio S, Petitto M, Maddalena G, Contaldo F, Mancini M. Obesity and cardiac function. Circulation 1981;64:477– 482.
  • Mathier MA, Zhang J, Ramanathan RC. Dramatic functional improvement following bariatric surgery in a patient with pulmonary arterial hypertension and morbid obesity. Chest 2008;133:789 –792.
Year 2016, Volume: 7 Issue: 27, 0 - 0, 18.06.2016
https://doi.org/10.17944/mkutfd.66764

Abstract

References

  • REFERANSLAR
  • Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systemic analysis of population health data. Lancet 2006;370:109-110.
  • Wolf HK, Tuomilehto J, Kuulasmaa K, Domarkiene S, Cepaitis Z, Molarius A, et al. Blood pressure levels in the 41 populations of the WHO MONICA project. J Hum Hypertens 1997;11:733-742.
  • Cassano PA, Segal MR, Vokonas PS, Weiss ST. Body fat distribution, blood pressure, and hypertension: a prospective cohort study of men in the normative aging study. Ann Epidemiol 1990;1:33-48.
  • Kastarinen MJ, Nissinen AM, Vartiainen EA. Blood pressure levels and obesity trends in hypertensive and normotensive Finnish population from 1982 to 1997. J Hypertens 2000;18:255-262.
  • Calle EE Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body –mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341:1097-1105.
  • Shimizu H, Timratana P, Schauer PR, Rogula T. Review of Metabolic Surgery for Type 2 Diabetes in Patients with a BMI < 35 kg/m(2). J Obes. 2012; 2012:147256.
  • Peterson LR, Waggoner AD, Schechtman KB Meyer T, Gropler RJ, Barzilai B, Dávila-Román VG. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 2004;43:1399–1404.
  • Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561–1566.
  • Hsuan CF, Huang CK, Lin JW, Lin LC, Lee TL. The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity 2010;18:1188-1193.
  • Lavie CJ, Milani RV, Ventura HO, Cardenas GA, Mehra MR, Messerli FH. Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol 2007;100:1460–1464.
  • Sahn DJ, DeMaria A, Kisslo J, Weyman A. The committee on M-mode standardization of the American Society of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072-1083.
  • Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450–458.
  • Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski GR, Ventura HO, Oigman W, Frohlich ED, Dunn FG. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med 1983;99:757–761.
  • Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225–236.
  • Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925–1932.
  • Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death: Increased ventricular ectoypy in cardiopathy of obesity. Arch Intern Med 1987; 147:1725-1728.
  • Bryan Ristow, John Rabkin, And Ernest Haeusslein. Improvement in Dilated Cardiomyopathy After Bariatric Surgery. Cardiac Fail 2008;14:198-202.
  • Howard J. Willens, Patricia Byers, Julio A. Chirinos, Eugenio Labrador, Joshua M. Hare,and Eduardo de Marchena. Effects of Weight Loss After Bariatric Surgery on Epicardial Fat Measured Using Echocardiography. Am J Cardiol 2007;99:1242–1245.
  • Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes. Obes Surg. 2015 Sep 2. DOI 10.1007/s11695-015-1866-5
  • Zarich SW, Kowalchuk GJ, McGuire MP, Benotti PN, Mascioli EA, Nesto RW. Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol 1991;68:377-381.
  • Chakko S, Mayor M, Allison MD, Kessler KM, Materson BJ, Myerburg RJ. Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity. Am J Cardiol 1991;68:95-98.
  • Ippisch HM1, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, Glascock BJ, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008 ;51(14):1342-1348.
  • Hurrel DG, Nishimura RA, Ilstrup DM, Appleton CP: Utelity of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 1997;30:459-467
  • Moller JE, Poulsen SH, Egstrup K: Effect of preload alterations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiographay 1999;12:1065-1072
  • Sokmen A, Sokmen G, Acar G, Akcay A, Koroglu S, Koleoglu M, et al. The impact of isolated obesity on right ventricular function in young adults. Arq Bras Cardiol 2013;101:160-168.
  • Chahal H, McClelland RL, Tandri H, Jain A, Turkbey EB, Hundley WG. Obesity and right ventricular structure and functions: the MESA-right ventricle study. Chest 2012;141:388-395.
  • de Divitiis O, Fazio S, Petitto M, Maddalena G, Contaldo F, Mancini M. Obesity and cardiac function. Circulation 1981;64:477– 482.
  • Mathier MA, Zhang J, Ramanathan RC. Dramatic functional improvement following bariatric surgery in a patient with pulmonary arterial hypertension and morbid obesity. Chest 2008;133:789 –792.
There are 29 citations in total.

Details

Journal Section Original Articles
Authors

AHMET Akçay

İmran Ceren This is me

Gürkan Acar

Huseyin Nacar This is me

Mehmet Çelebi

Kemal Göçer This is me

İdris Ardıç

Abdullah Sökmen

Publication Date June 18, 2016
Submission Date February 24, 2016
Published in Issue Year 2016 Volume: 7 Issue: 27

Cite

Vancouver Akçay A, Ceren İ, Acar G, Nacar H, Çelebi M, Göçer K, Ardıç İ, Sökmen A. Bariatrik Cerrahi ile Kilo Kaybının Kardiyak Fonksiyonlara Etkisinin Ekokardiyografi İle Değerlendirilmesi. mkutfd. 2016;7(27).