Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents
Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents
Objectives: The purpose of this study was to evaluate changes in cardiac geometry, systolic and diastolic function before and after weight loss in morbidly obese adolescents.
Background: Cardiac abnormalities are present in morbidly obese adolescents; however, it is unclear if they are reversible with weight loss.
Methods: Data from 38 adolescents (13 to 19 years; 29 females, 9 males, 33 Caucasians, 5 African Americans) were evaluated before and after bariatric surgery. Left ventricular mass (LVM), left ventricular (LV) geometry, systolic and diastolic function were assessed by echocardiography. Mean follow up was 10 ± 3 months.
Results: Weight and body mass index decreased post-operatively (mean weight loss 59 ± 15 kg, pre-operative body mass index 60 ± 9 kg/m vs. follow-up 40 ± 8 kg/m, p < 0.0001). Change in LVM index (54 ± 13 g/m to 42 ± 10 g/m, p < 0.0001) correlated with weight loss (r = 0.41, p = 0.01). Prevalence of concentric left ventricular hypertrophy (LVH) improved from 28% at pre-operative to only 3% at follow up (p = 0.007), and normal LV geometry improved from 36% to 79% at follow up (p = 0.009). Diastolic function also improved (mitral E/Ea lateral 7.7 ± 2.3 at pre-operative vs. 6.3 ± 1.6 at post-operative, p = 0.003). In addition, rate-pressure product improved suggesting decreased cardiac workload (p < 0.001).
Conclusions: Elevated LVM index, concentric LVH, altered diastolic function, and cardiac workload significantly improve following surgically induced weight loss in morbidly obese adolescents. Large weight loss due to bariatric surgery improves predictors of future cardiovascular morbidity in these young people.
Morbid obesity (body mass index [BMI] ≥40 kg/m) affects over 1 million adolescents and young adults, and being obese as an adolescent is predictive of remaining obese into adulthood. Little is known about the reversibility of cardiac abnormalities in morbidly obese adolescents. The purpose of this study was to determine whether cardiac abnormalities reverse with significant weight loss in adolescents. An important model for this evaluation is bariatric surgery, because rapid and profound weight loss occurs over a short period of time, such that plasticity, if present, might be demonstrated.
Abstract and Introduction
Abstract
Objectives: The purpose of this study was to evaluate changes in cardiac geometry, systolic and diastolic function before and after weight loss in morbidly obese adolescents.
Background: Cardiac abnormalities are present in morbidly obese adolescents; however, it is unclear if they are reversible with weight loss.
Methods: Data from 38 adolescents (13 to 19 years; 29 females, 9 males, 33 Caucasians, 5 African Americans) were evaluated before and after bariatric surgery. Left ventricular mass (LVM), left ventricular (LV) geometry, systolic and diastolic function were assessed by echocardiography. Mean follow up was 10 ± 3 months.
Results: Weight and body mass index decreased post-operatively (mean weight loss 59 ± 15 kg, pre-operative body mass index 60 ± 9 kg/m vs. follow-up 40 ± 8 kg/m, p < 0.0001). Change in LVM index (54 ± 13 g/m to 42 ± 10 g/m, p < 0.0001) correlated with weight loss (r = 0.41, p = 0.01). Prevalence of concentric left ventricular hypertrophy (LVH) improved from 28% at pre-operative to only 3% at follow up (p = 0.007), and normal LV geometry improved from 36% to 79% at follow up (p = 0.009). Diastolic function also improved (mitral E/Ea lateral 7.7 ± 2.3 at pre-operative vs. 6.3 ± 1.6 at post-operative, p = 0.003). In addition, rate-pressure product improved suggesting decreased cardiac workload (p < 0.001).
Conclusions: Elevated LVM index, concentric LVH, altered diastolic function, and cardiac workload significantly improve following surgically induced weight loss in morbidly obese adolescents. Large weight loss due to bariatric surgery improves predictors of future cardiovascular morbidity in these young people.
Introduction
Morbid obesity (body mass index [BMI] ≥40 kg/m) affects over 1 million adolescents and young adults, and being obese as an adolescent is predictive of remaining obese into adulthood. Little is known about the reversibility of cardiac abnormalities in morbidly obese adolescents. The purpose of this study was to determine whether cardiac abnormalities reverse with significant weight loss in adolescents. An important model for this evaluation is bariatric surgery, because rapid and profound weight loss occurs over a short period of time, such that plasticity, if present, might be demonstrated.