Effect of bariatric surgery on cardiac structure and function in obese patients: role of the renin-angiotensin system

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• dc.contributor.author Oliveras, Anna
• dc.contributor.author Molina Ferragut, Luis
• dc.contributor.author Goday Arno, Alberto
• dc.contributor.author Sans Atxer, Laia
• dc.contributor.author Riera, Marta
• dc.contributor.author Vázquez, Susana
• dc.contributor.author Benaiges Foix, David
• dc.contributor.author Granados, Ana Marina
• dc.contributor.author Ramon, Jose Manuel
• dc.contributor.author Pascual Santos, Julio
• dc.date.accessioned 2021-10-13T06:51:59Z
• dc.date.available 2021-10-13T06:51:59Z
• dc.date.issued 2021
• dc.description.abstract Echocardiographic alterations have been described in obesity, but their modifications after bariatric surgery (BS) and mechanisms are little known, mostly in normotensive patients. We aimed to analyze cardiac changes 1 year post-BS and to explore possible mechanisms. A cohort of patients with severe obesity (58% normotensives) were prospectively recruited and examined before surgery and after 12 months. Clinical and echocardiographic data, 24 h BP, renin-angiotensin-aldosterone system (RAAS) components, cytokines, and inflammatory markers were analyzed at these two time points. Overall reduction in body weight was mean (IQR) = 30.0% (25.9-33.8). There were statistically significant decreases in left ventricle mass index2.7 (LVMI)2.7 , septum thickness (ST), posterior wall thickness (PWT), relative wall thickness (RWT), and E/e', both in the whole cohort and in patients without RAAS blockers (p ≤ .04 for all). Plasma renin activity (PRA) decreased from (median, IQR) = 0.8 (0.3;1.35) to 0.4 (0.2;0.93) ng/ml/h, plasma aldosterone from 92 (58.6;126) to 68.1 (56.2;83.4) ng/dl, and angiotensin-converting enzyme (ACE)-2 activity from 7.7 (5.7;11.8) to 6.8 (5.3;11.2) RFU/µl/h, p < .05. The body weight loss correlated with a decrease in both 24 h SBP and 24 h DBP (Pearson's coefficient 0.353, p = .022 and 0.384, p = .012, respectively). Variation (Δ) of body weight correlated with ΔE/e' (Pearson's coeff. 0.414, p = .008) and with Δ lateral e' (Pearson's coeff. = -0.363, p = .018). Generalized linear models showed that ΔPRA was an independent variable for the final (12-months post-BS) LVMI2.7 (p = .028). No other changes in cardiac parameters correlated with ΔBP. In addition to the respective baseline value, final values of PWT and RWT were dependent on 12-month Δ of PRA, ACE, and ACE/ACE2 (p < .03 for all). We conclude that there are cardiac changes post-BS in patients with severe obesity, normotensives included. Structural changes appear to be related to modifications in the renin-angiotensin axis.
• dc.format.mimetype application/pdf
• dc.identifier.citation Oliveras A, Molina L, Goday A, Sans L, Riera M, Vazquez S, et al. Effect of bariatric surgery on cardiac structure and function in obese patients: role of the renin-angiotensin system. J Clin Hypertens (Greenwich). 2021 Jan;23(1):181-92. DOI: 10.1111/jch.14129
• dc.identifier.doi http://dx.doi.org/10.1111/jch.14129
• dc.identifier.issn 1524-6175
• dc.identifier.uri http://hdl.handle.net/10230/48639
• dc.language.iso eng
• dc.publisher Wiley
• dc.rights © 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, https://creativecommons.org/licenses/by-nc/4.0/, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Angiotensin-converting enzyme 2
• dc.subject.keyword Bariatric surgery
• dc.subject.keyword Blood pressure
• dc.subject.keyword Echocardiography
• dc.subject.keyword Renin-angiotensin axis
• dc.subject.keyword Severe obesity
• dc.title Effect of bariatric surgery on cardiac structure and function in obese patients: role of the renin-angiotensin system
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion