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CLINICAL RESEARCH: OBESITY AND CARDIAC FUNCTION

Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents

Holly M. Ippisch, MD, MS^_*,_*, Thomas H. Inge, MD, PhD, Stephen R. Daniels, MD, PhD, FACC, Baiyang Wang, MS^_*, Philip R. Khoury, MS^_*, Sandra A. Witt, RDCS^_*, Betty J. Glascock, RDCS^_*, Victor F. Garcia, MD and Thomas R. Kimball, MD, FACC^_*

^_* Division of Cardiology, Cincinnati Children’s Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Department of Pediatrics, The Children’s Hospital, Denver, Colorado.

Manuscript received May 24, 2007; revised manuscript received December 17, 2007, accepted December 18, 2007.

^_* Reprint requests and correspondence: Dr. Holly M. Ippisch, Cincinnati Children’s Hospital Medical Center, Division of Pediatric Cardiology, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229. (Email: Holly.Ippisch{at}cchmc.org).

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/m² vs. follow-up 40 ± 8 kg/m², p < 0.0001). Change in LVM index (54 ± 13 g/m^2.7 to 42 ± 10 g/m^2.7, 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.

Abbreviations and Acronyms   BMI = body mass index   CV = cardiovascular   DBP-z = diastolic blood pressure z score   IBW = ideal body weight   IVSd = end-diastolic septal thickness   LA = left atrium/atrial   LVED = left ventricular end-diastolic dimension   LVES = left ventricular end-systolic dimension   LVH = left ventricular hypertrophy   LVM = left ventricular mass   LVPWd = end-diastolic left ventricular posterior wall thickness   RWT = relative wall thickness   SBP-z = systolic blood pressure z score   SF = shortening fraction   VCF = velocity of circumferential fiber shortening   WS = wall stress

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