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Does the Right Heart Benefit From Bariatric Surgery?
Pulmonary Vascular Disease SESSION TITLE: Pulmonary Vascular Disease II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
Does the Right Heart Benefit From Bariatric Surgery? Elie Homsy MD* David Bradley MD; and Elisa Bradley MD The Ohio State University Wexner Medical Center, Columbus, OH PURPOSE: Pulmonary hypertension (WHO group II) is increasingly recognized in obese, metabolically abnormal adults. With more than 35% of the U.S. adult population affected by obesity, this association may be an important comorbid condition requiring longitudinal care. We sought to define average pulmonary pressures and measures of diastolic dysfunction by echocardiogram, and changes in these parameters, in adults undergoing bariatric surgery. METHODS: We queried our internal database to identify all patients who underwent bariatric surgery between 2011-2015. Pre and post-surgery echocardiogram images were required for inclusion in this study. Two independent investigators reviewed echocardiograms for measures of diastolic dysfunction (E/e’), right ventricular systolic pressure (RVSP) and right heart function (tricuspid annular plane excursion - TAPSE and S’).
CONCLUSIONS: In this single-center study, a minority of patients undergoing bariatric surgery have an evaluation of diastolic function and/or screening for WHO group II pulmonary hypertension. Of those who had pre and post-surgery echocardiograms available, despite significant weight loss and improvement in metabolic studies, there was no change in pulmonary pressures, right heart function, or diastolic filling pattern. CLINICAL IMPLICATIONS: The study did not reveal a significant change in right heart parameters on echocardiogram but it was limited by a small sample size. Larger, more inclusive studies of all patients undergoing bariatric surgery are required to determine whether or not there is a benefit. DISCLOSURE: The following authors have nothing to disclose: Elie Homsy, David Bradley, Elisa Bradley No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1294
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1185A
PULMONARY VASCULAR DISEASE
RESULTS: Of patients who underwent bariatric surgery during the study timeframe, 18 had pre and post-surgery echocardiogram images available for review. Average age at the time of surgery was 50+13 years and 44% were men. At 2.2+1.2 years of follow-up, there was a significant decline in weight (341+76 vs. 250+77 pounds, p<0.001), fasting glucose (120+26, 102+32 mg/dL, p<0.01), triglyceride level (150+74, 100+35 mg/dL, p<0.05), LDL (99+43, 76+31 mg/dL, p<0.05) and HDL (40+10, 47+15 mg/dL, p<0.05). On average, patients lost 26+16% of body weight between studies. Despite significant changes in weight, glucose and lipid studies, echocardiogram-derived measures of diastolic function (E/e’: 10.5+4.4 vs. 9.3+4.0) and right ventricular pressure (RVSP: 18.9+10.8 vs. 21.2+11.6) and function (TAPSE: 2.2+0.6 vs. 2.3+0.6 and S’: 13.3+1.8 vs. 14.1+4.0) were not significantly different after bariatric surgery.
Does the Right Heart Benefit From Bariatric Surgery? Elie Homsy MD* David Bradley MD; and Elisa Bradley MD The Ohio State University Wexner Medical Center, Columbus, OH PURPOSE: Pulmonary hypertension (WHO group II) is increasingly recognized in obese, metabolically abnormal adults. With more than 35% of the U.S. adult population affected by obesity, this association may be an important comorbid condition requiring longitudinal care. We sought to define average pulmonary pressures and measures of diastolic dysfunction by echocardiogram, and changes in these parameters, in adults undergoing bariatric surgery. METHODS: We queried our internal database to identify all patients who underwent bariatric surgery between 2011-2015. Pre and post-surgery echocardiogram images were required for inclusion in this study. Two independent investigators reviewed echocardiograms for measures of diastolic dysfunction (E/e’), right ventricular systolic pressure (RVSP) and right heart function (tricuspid annular plane excursion - TAPSE and S’).
CONCLUSIONS: In this single-center study, a minority of patients undergoing bariatric surgery have an evaluation of diastolic function and/or screening for WHO group II pulmonary hypertension. Of those who had pre and post-surgery echocardiograms available, despite significant weight loss and improvement in metabolic studies, there was no change in pulmonary pressures, right heart function, or diastolic filling pattern. CLINICAL IMPLICATIONS: The study did not reveal a significant change in right heart parameters on echocardiogram but it was limited by a small sample size. Larger, more inclusive studies of all patients undergoing bariatric surgery are required to determine whether or not there is a benefit. DISCLOSURE: The following authors have nothing to disclose: Elie Homsy, David Bradley, Elisa Bradley No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1294
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1185A
PULMONARY VASCULAR DISEASE
RESULTS: Of patients who underwent bariatric surgery during the study timeframe, 18 had pre and post-surgery echocardiogram images available for review. Average age at the time of surgery was 50+13 years and 44% were men. At 2.2+1.2 years of follow-up, there was a significant decline in weight (341+76 vs. 250+77 pounds, p<0.001), fasting glucose (120+26, 102+32 mg/dL, p<0.01), triglyceride level (150+74, 100+35 mg/dL, p<0.05), LDL (99+43, 76+31 mg/dL, p<0.05) and HDL (40+10, 47+15 mg/dL, p<0.05). On average, patients lost 26+16% of body weight between studies. Despite significant changes in weight, glucose and lipid studies, echocardiogram-derived measures of diastolic function (E/e’: 10.5+4.4 vs. 9.3+4.0) and right ventricular pressure (RVSP: 18.9+10.8 vs. 21.2+11.6) and function (TAPSE: 2.2+0.6 vs. 2.3+0.6 and S’: 13.3+1.8 vs. 14.1+4.0) were not significantly different after bariatric surgery.