One-year impact of bariatric surgery on echocardiographic markers of vascular disease: results from the prospective FatWest study

Abstract

Abstract Background Aortic root plaque and aortic valve sclerosis (AVS) are known echocardiographic markers of atherosclerosis. Obesity increases the atherothrombotic risk, while large surgical weight loss improves the cardiovascular risk profile. It is unclear whether the severity of vascular disease associated with severe obesity changes after bariatric surgery. Purpose To assess the 1-year impact of bariatric surgery on aortic root wall thickness (ART) and AVS. Methods 91 severely obese patients (43±10 years, preoperative body mass index [BMI] 41.7±4.9 kg/m2, 55% hypertensive, 17% diabetic) underwent echocardiography preoperatively and 14 months after Roux-en-Y bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic maximum ART and categorized AVS as mild, moderate or severe based on combined aortic cusp thickness and hyperechoic valve lesions. Left ventricular (LV) structural remodelling was assessed by LV mass and geometry. In 52 patients with clinical signs of obstructive sleep apnea, preoperative polysomnography data including apnea-hypopnea index and mean nightly oxygen saturation were evaluated. Results Preoperatively, 39% had mild-moderate AVS, and an average ART of 4.9±1.7mm (Figures 1–2). Presence of AVS at baseline was associated with higher LV mass, while ART was higher in men, older patients and increased with lower nightly oxygen saturation (r=−0.29, p<0.05). During the first preoperative 14 months, patients experienced a 12.9±3.8kg/m2 BMI and 0.6±1.9mm ART reduction, and AVS prevalence lowered by 45% (Figures 1 and 2). In backward stepwise multivariate regression analyses with adjustment for changes in clinical variables, LV mass and geometry, less ART reduction at 14 months was independently predicted by higher age, higher postoperative BMI and presence of AVS (R2 0.53, all p<0.05). Persistent AVS was associated with higher age and preoperative diabetes (R2 0.24, p<0.05). Conclusion In patients undergoing bariatric surgery, a reduction in echocardiographic markers of vascular disease was observed 1 year postoperatively, particularly in younger, non-diabetic patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Vest Figure 1Figure 2