Weight Loss After Bariatric Surgery Significantly Improves Carotid and Cardiac Function in Apparently Healthy People wit
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ORIGINAL CONTRIBUTIONS
Weight Loss After Bariatric Surgery Significantly Improves Carotid and Cardiac Function in Apparently Healthy People with Morbid Obesity Alessandro Giudici 1 & Carlo Palombo 2 & Michaela Kozakova 3 & Carmela Morizzo 2 & Lorenzo Losso 2 & Monica Nannipieri 3 & Rossana Berta 4 & Alun D. Hughes 5 & J. Kennedy Cruickshank 6 & Ashraf W. Khir 1
# The Author(s) 2020
Abstract Purpose Obesity clearly increases cardiovascular risk, often inducing high blood pressure (BP), impaired left ventricular (LV) function, and increased arterial stiffness. Intensive weight loss and bariatric surgery induce improvement in hypertension and diabetes for morbid obesity. Carotid artery haemodynamics is a powerful prognostic indicator for stroke and cognitive decline independent of BP. The aim of this study was to evaluate the impact of a 3-stage bariatric strategy of diet, bariatric surgery, and consequent weight loss on carotid haemodynamics and cardiac diastolic function. Material and Methods This prospective study included 26 patients (45 ± 10 years, 4 men) with severe obesity undergoing bariatric surgery without comorbidities (hypertension, diabetes, etc.). Anthropometry, BP, Doppler echocardiography, and common carotid haemodynamics by ultrasound were measured at three times: (1) baseline, (2) after 1-month diet (post-diet), and (3) 8 months after surgery (post-surgery). The lnDU-loop method was used to estimate local carotid pulse wave velocity (ncPWV). Results Baseline BMI was 47.9 ± 7.1 kg/m2 and reduced by 5% and 30% post-diet and post-surgery, respectively. BP decreased only post-diet, without pulse pressure change. However, ncPWV, 6.27 ± 1.35 m/s at baseline, was significantly reduced by 10% and 23% post-diet and post-surgery, respectively, also adjusted for BP changes. The E/A ratio rose from 0.95 ± 0.20 to 1.27 ± 0.31 (p < 0.005), without change in LV geometry or mass, while heart rate and cardiac output fell substantially. Alessandro Giudici and Carlo Palombo contributed equally to this work. * Ashraf W. Khir [email protected] Alessandro Giudici [email protected]
J. Kennedy Cruickshank [email protected] 1
Department of Mechanical and Aerospace Engineering, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, UK
Michaela Kozakova [email protected]
2
Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Tuscany, Italy
Carmela Morizzo [email protected]
3
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Tuscany, Italy
4
Bariatric Surgery Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Tuscany, Italy
5
Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London, Middlesex, UK
6
School of Life-Course/Nutritional Sciences, King’s College, St. Thomas’ & Guy’s Hospitals, London, Middlesex, UK
Carlo Palombo [email protected]
Lorenzo Losso [email protected] Monica Na
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