Early Improvement in Left Ventricular Mechanics After Laparoscopic Sleeve Gastrectomy Detected by Global Longitudinal Strain

Öz

Aim: Obesity is associated with structural and functional cardiac abnormalities, including left ventricular hypertrophy, diastolic dysfunction, and subclinical myocardial impairment. Global longitudinal strain (GLS) is a sensitive marker for detecting early myocardial impairment before changes in left ventricular ejection fraction (LVEF) occur. This study aimed to evaluate the early effects of laparoscopic sleeve gastrectomy (LSG) on cardiac remodeling and myocardial mechanics using conventional and speckle-tracking echocardiography. Methods: This retrospective single-center study included 66 patients with severe obesity who underwent LSG. Clinical, metabolic, and echocardiographic parameters were evaluated before surgery and at a mean follow-up of approximately 3-6 months. Conventional and speckle-tracking echocardiography were used to assess left ventricular structure and myocardial mechanics. Preoperative and postoperative parameters were compared using paired-samples t-test. Results: The mean age was 36.9 ± 11.7 years, and 75.8% of patients were female. Following LSG, significant reductions were observed in body weight, body mass index, and blood pressure (all p<0.001), accompanied by improvements in glucose and lipid metabolism. Echocardiographic evaluation revealed significant reductions in left atrial volume, left ventricular dimensions and mass, as well as improved diastolic function parameters, including E/A and E/e′ ratios (both p<0.001). Despite no significant change in LVEF, GLS improved significantly after surgery (20.0 ± 2.7% vs. 21.8 ± 2.4%, p<0.001), indicating early recovery of subclinical myocardial dysfunction. Conclusion: LSG is associated with significant early reverse cardiac remodeling and improvement in subclinical myocardial dysfunction. GLS appears to be more sensitive than conventional echocardiographic systolic indices for detecting early myocardial recovery following bariatric surgery.

Anahtar Kelimeler

• Obesity
• laparoscopic sleeve gastrectomy
• global longitudinal strain
• reverse cardiac remodeling
• speckle-tracking echocardiography
• myocardial dysfunction

Laparoskopik Sleeve Gastrektomi Sonrası Sol Ventrikül Mekaniğinde Global Longitudinal Strain ile Tespit Edilen Erken İyileşme

Öz

Amaç: Obezite, sol ventrikül hipertrofisi, diyastolik disfonksiyon ve subklinik miyokardiyal hasar dahil olmak üzere yapısal ve fonksiyonel kardiyak anormalliklerle ilişkilidir. Global longitudinal strain (GLS), sol ventrikül ejeksiyon fraksiyonunda (LVEF) değişiklikler meydana gelmeden önce erken miyokardiyal hasarı tespit etmek için hassas bir belirteçtir. Bu çalışma, laparoskopik sleeve gastrektominin (LSG) kardiyak yeniden şekillenme ve miyokart mekaniği üzerindeki erken etkilerini geleneksel ve speckle-tracking ekokardiyografi kullanarak değerlendirmeyi amaçlamıştır. Yöntemler: Bu retrospektif tek merkezli çalışmaya, LSG uygulanan ciddi obez 66 hasta dahil edilmiştir. Klinik, metabolik ve ekokardiyografik parametreler ameliyattan önce ve ameliyat sonrası ortalama 3-6 aylık bir takip süresinde değerlendirilmiştir. Sol ventrikül yapısı ve miyokardiyal mekaniği değerlendirmek için geleneksel ve speckle-tracking ekokardiyografi kullanılmıştır. Ameliyat öncesi ve sonrası parametreler, eşleştirilmiş örneklem t-testi kullanılarak karşılaştırılmıştır. Sonuçlar: Ortalama yaş 36,9 ± 11,7 yıl olup hastaların %75,8'i kadındı. LSG sonrası vücut ağırlığı, vücut kitle indeksi ve kan basıncında anlamlı azalmalar gözlendi (tümü p<0,001) ve buna glikoz ve lipid metabolizmasında iyileşmeler eşlik etti. Ekokardiyografik değerlendirme, sol atriyum hacminde, sol ventrikül boyutlarında ve kütlesinde anlamlı azalmaların yanı sıra E/A ve E/e′ oranları da dahil olmak üzere diyastolik fonksiyon parametrelerinde iyileşmeler ortaya koydu (her ikisi için de p<0,001). LVEF'de anlamlı bir değişiklik olmamasına rağmen, GLS ameliyat sonrası anlamlı derecede iyileşti (-20,0 ± 2,7% vs. -21,8 ± 2,4%, p<0,001), bu da subklinik miyokardiyal disfonksiyonun erken iyileşmesini göstermektedir. Sonuç: LSG, anlamlı erken ters kardiyak yeniden şekillenme ve subklinik miyokardiyal disfonksiyonda iyileşme sağlamıştır. GLS, bariatrik cerrahi sonrası erken miyokart iyileşmesini tespit etmede geleneksel ekokardiyografik sistolik indekslerden daha hassas görünmektedir.

Anahtar Kelimeler

• obezite
• laparoskopik tüp mide ameliyatı
• ters kardiyak yeniden şekillenme
• global longitudinal strain
• benek izleme ekokardiyografisi
• miyokardiyal disfonksiyon

Kaynakça

1. Santos ECL, del Castillo JM, Parente GBO, Pedrosa RP, Gadelha PSG, Lopes RD, et al. Changes in left ventricular mechanics after sleeve gastrectomy. Obes Surg. 2020;30(2):580-586. doi:10.1007/s11695-019-04216-5
2. Ruano-Campos A, Cruz-Utrilla A, López-Antoñanzas L, Luaces M, de Isla LP, Herrera MAR, et al. Evaluation of myocardial function following SADI-S. Obes Surg. 2021;31(7):3109-3115. doi:10.1007/s11695-021-05349-2
3. Tuluce K, Kara C, Tuluce SY, Cetin N, Caner Topaloglu C, Bozkaya YT, et al. Early reverse cardiac remodeling effect of laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(2):364-375. doi:10.1007/s11695-016-2301-2
4. Leung M, Xie M, Durmush E, Leung DY, Wong VW. Weight loss with sleeve gastrectomy in obese type 2 diabetes mellitus: impact on cardiac function. Obes Surg. 2016;26(2):321-326. doi:10.1007/s11695-015-1748-x
5. Meng W, Peng R, Du L, Zheng Y, Liu D, Qu S, et al. Weight loss after laparoscopic sleeve gastrectomy ameliorates cardiac remodeling in obese Chinese patients. Front Endocrinol (Lausanne). 2022;12:799537. doi:10.3389/fendo.2021.799537
6. Cavarretta E, Casella G, Calì B, Dammaro C, Biondi-Zoccai G, Iossa A, et al. Cardiac remodeling in obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23:565-572. doi:10.1007/s00268-012-1874-8
7. Izzo C, Visco V, Cirillo A, Bonadies D, Caliendo G, Rusciano MR, et al. Retrospective study on short-term reverse cardiac remodeling in obese patients undergoing sleeve gastrectomy. J Cardiovasc Dev Dis. 2024;11:389. doi:10.3390/jcdd11120389
8. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39.e14. doi:10.1016/j.echo.2014.10.003

9. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277-314. doi:10.1016/j.echo.2016.01.011
10. Esparham A, Shoar S, Kheradmand HR, Ahmadyar S, Dalili A, Rezapanah A, et al. The impact of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Obes Surg. 2023;33:345-361. doi:10.1007/s11695-022-06396-z
11. Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H, et al. The effects of bariatric surgery on cardiac structure and function: a systematic review of cardiac imaging outcomes. Obes Surg. 2016;26:1030-1040. doi:10.1007/s11695-015-1866-5
12. Şimşek MA, Türer Cabbar A, Özveren O, Aydın S, Taşçılar Ö, Muzaffer Değertekin M, et al. Short-term effects of sleeve gastrectomy on weight loss and diastolic function in obese patients. Turk Kardiyol Dern Ars. 2019;47:162-167. doi:10.5543/tkda.2018.95994
13. Inci S, Gül M, Alsancak Y, Ozkan N. Short- and mid-term effects of sleeve gastrectomy on left ventricular function with two-dimensional speckle tracking echocardiography in obese patients. Echocardiography. 2019;36:2019-2025. doi:10.1111/echo.14522
14. Ding X, Zhang X, Zhao J, Wei C, Luo S, Yuan J, et al. Effects of weight loss after sleeve gastrectomy on left ventricular myocardial work in obese patients. Front Cardiovasc Med. 2025;12:1525746. doi:10.3389/fcvm.2025.1525746
15. Öz TK, Dayı ŞÜ, Seyit H, Öz A, Ösken A, Atasoy I, et al. The effects of weight loss after sleeve gastrectomy on left ventricular systolic function in men versus women. J Clin Ultrasound. 2016;44:492-499. doi:10.1002/jcu.22361
16. Kaya BC, Elkan H. Impact of weight loss with laparoscopic sleeve gastrectomy on left ventricular diastolic function: a prospective study. Obes Surg. 2020;30:3280-3286. doi:10.1007/s11695-020-04573-6
17. Büber İ, Aykota MR, Sevgican Cİ, Adalı MK, et al. The effects of laparoscopic sleeve gastrectomy on cardiac diastolic function, aortic elasticity, and atrial electromechanics delay. Obes Surg. 2021;31:3571-3578. doi:10.1007/s11695-021-05431-9
18. Henry JA, Abdesselam I, Deal O, Lewis AJ, Rayner J, Bernard M, et al. The effect of bariatric surgery type on cardiac reverse remodelling. Int J Obes (Lond). 2024;48:808-814. doi:10.1038/s41366-024-01474-x
19. Sampedro MEA, Gómez FI, Ortega MG, Soler IO, Guirao AJS, Caparrós EP, et al. Impact of ponderal loss after bariatric surgery on cardiac structure and function. Med Clin (Barc). 2022;159:109-115. doi:10.1016/j.medcli.2021.09.018