心脏磁共振评估左心室射血分数保留肥胖者减重术后左心室结构和功能的改变

蒲倩; 唐露; 彭鹏飞; 明悦; 杨慧义; 岳书婷; 郦峥; 程中; 陈亿; 孙家瑜

doi:10.12182/20241160503

心脏磁共振评估左心室射血分数保留肥胖者减重术后左心室结构和功能的改变

Left Ventricular Structural and Functional Changes in Obese Subjects With Preserved Left Ventricular Ejection Fraction After Bariatric Surgery: Assessment With Cardiac Magnetic Resonance Imaging

摘要

摘要:
目的应用心脏磁共振（cardiac magnetic resonance, CMR）成像探讨肥胖者行减重手术后左心室结构和功能的纵向改变与术前左心室射血分数（left ventricular ejection fraction, LVEF）的关系。
方法前瞻性纳入拟行胃袖状切除术的肥胖者75例和年龄、性别匹配的健康对照（对照组）46例，均行CMR检查，得到左心室结构参数、LVEF和应变参数。根据术前LVEF将肥胖者分为LVEF≥60%（n=43）和50%≤LVEF<60%（n=32）两组，比较对照组和两组肥胖者的左心室结构和功能差异。最终有38例肥胖者同时完成减重术后1个月及12个月的CMR随访。分别比较LVEF≥60%组（n=20）和50%≤LVEF<60%组（n=18）肥胖者术后左心室结构和功能的纵向改变。
结果减重术前，LVEF≥60%组的整体纵向应变低于对照组，差异有统计学意义〔（−18.36±1.86）% vs. （−19.50±1.53）%，P<0.05〕；50%≤LVEF<60%组的径向〔（27.70±3.52）% vs. （34.44±4.11）%，P<0.05〕、周向〔（−17.35±1.46）% vs. （−19.85±1.42）%，P<0.05〕、纵向〔（−16.22±1.81）% vs. （−19.50±1.53）%，P<0.05〕的整体应变低于对照组，差异有统计学意义。减重术后12个月，LVEF≥60%组的径向〔（32.52±7.84）% vs. （30.92±4.27）%, P>0.05〕、周向〔（−19.02±2.42）% vs. （−18.63±1.49）%, P>0.05〕、纵向〔（−18.18±2.06）% vs. （−17.78±1.66）%, P>0.05〕的整体应变较减重术前的差异无统计学意义；50%≤LVEF<60%组的径向〔（32.73±5.86）% vs. （26.83±4.85）%，P<0.05〕、周向〔（−19.10±2.00）% vs. （−16.91±2.09）%，P<0.05〕的整体应变高于减重手术前，差异有统计学意义。
结论肥胖者减重术后左心室会发生重构逆转，左心室结构和功能的纵向改变情况因术前LVEF不同而存在差异。

Abstract:
Objective To investigate the longitudinal changes in left ventricular (LV) structure and function after bariatric surgery in obese individuals and their relationship with preoperative left ventricular ejection fraction (LVEF) by cardiac magnetic resonance (CMR) imaging.
Methods We prospectively enrolled 75 obese subjects scheduled for laparoscopic sleeve gastrectomy and 46 age and sex-matched healthy controls (the control group). All subjects underwent CMR examination to obtain LV structural parameters, LVEF, and strain parameters. According to their preoperative LVEF, the obese subjects were divided into two obesity groups, including the group of patients with LVEF≥60% (n=43) and the group of patients with 50%≤LVEF<60% (n=32). LV structural and functional differences between the control group and the two obesity groups were compared. Eventually, 38 obese subjects completed the CMR follow-up at 1 month and 12 months after bariatric surgery. The longitudinal changes in LV structure and function after surgery in the LVEF≥60% (n=20) group and the 50%≤LVEF<60% group (n=18) were compared.
Results Before bariatric surgery, the global longitudinal strain was significantly lower in the LVEF≥60% group than that in the control group (−18.36±1.86% vs. −19.50±1.53%, P<0.05). The global radial (27.70±3.52% vs. 34.44±4.11%, P<0.05), circumferential (−17.35±1.46% vs. −19.85±1.42%, P<0.05), and longitudinal (−16.22±1.81% vs. −19.50±1.53%, P<0.05) strain in the 50%≤LVEF<60% group was significantly lower than that in the control group. At 12 months after bariatric surgery, the global radial (32.52±7.84% vs. 30.92±4.27%, P>0.05), circumferential (−19.02±2.42% vs. −18.63±1.49%, P>0.05), and longitudinal (−18.18±2.06% vs. −17.78±1.66%, P>0.05) strain in the LVEF≥60% group showed no significant difference compared with the baseline findings. In the 50%≤LVEF<60% group, the global radial (32.73±5.86% vs. 26.83±4.85%, P<0.05) and circumferential (−19.10±2.00% vs. −16.91±2.09%, P<0.05) strain was significantly higher than that before surgery.
Conclusion LV remodeling is reversed after bariatric surgery in obese subjects, and the longitudinal changes in LV structure and function vary with the preoperative LVEF.

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