Impact of Weight Loss on Epicardial Fat and Carotid Intima Media Thickness After Laparoscopic Sleeve Gastrectomy: A Prospective Study

Abstract

Background and aims: Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis.

Methods and results: Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 +/- 12.42 were prospectively enrolled. On Bmode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at enddiastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Delta) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 +/- 7.54 to 33.54 +/- 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 +/- 1.95 mm vs. 7.41 +/- 1.87 mm; p < 0.001 and 0.74 +/- 0.13 mm vs. 0.67 +/- 0.11 mm; p < 0.001 respectively). A significant correlation between Delta EFT and Delta MI (r = 0.431, p < 0.001) was shown. Delta CIMT is significantly correlated with Delta EFT, Delta BMI and Delta systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only Delta BMI was the independent predictor of Delta EFT (beta = 153, p = 0.001).

Conclusion: Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients. (C) 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.