Impact of Laparoscopic Sleeve Gastrectomy on cardiac functions and biomarkers

BACKGROUND: Obesity-related cardiovascular diseases (CVD), which have reached pandemic proportions and become a major cause of morbidity and mortality in the world, not only significantly affect public health but also impose a serious economic burden. There is a lack of comprehensive studies evaluating the effects of Laparoscopic Sleeve Gastrectomy (LSG), which has recently started to be applied as the primary technique among bariatric surgical procedures, not only on overt CVD but also on precursor pathological processes in the context of subclinical myocardial damage. PURPOSE: This study aims to investigate the effects of LSG on cardiac functions assessed by cardiac magnetic resonance (CMR), on patients' CVD risk and quality of life (QoL), and on various biomarkers. METHODS: 32 consecutive obese patients who were scheduled for LSG were included. The patients were evaluated prior to LSG and at an average of 8.4 months following surgery. Blood samples were taken for routine biochemical parameters, anthropometric evaluations and blood pressure measurements were performed. Imaging was performed using a 16-channel phased array body coil on a 1.5 Tesla MRI unit (Achieva, Philips, Netherlands). Left ventricular mass (LVM) and ejection fraction (LVEF), stroke volume (LVSV), end-systolic volume (LVESV), end-diastolic volume (LVEDV), mitral annular plane systolic excursion (MAPSE) and Left Ventricular Global Longitudinal Strain (LVGLS) analysis with cardiac MRI-FT technique were performed offline using four-chamber and two-chamber CINE images with CVI 42 software (Circle CVi, Calgary Canada). The patients' 10-year CVD risk was estimated using the Framingham Risk Score (FRS). The QoL Short Form-36 (QoL SF-36) was administered. Blood specimens were analyzed by ELISA to measure the serum concentration of Endotrophin (ETP), Apelin, Adiponectin, Galectin-3 (GAL-3) and Fatty Acid Binding Protein 4 (FABP4). IBM SPSS for Windows Version 26.0 was used for statistical analysis. RESULTS: The mean age was 36.3 ± 7.6 years and 81.3% of patients were female. Following LSG, BMI and waist circumference (WC) were reduced significantly (41.1 ± 4.8 kg/m² vs. 28.8 ± 4.1 kg/m², P <0.001; 120.0 ± 12.7 cm vs. 93.9 ± 11.6 cm, P <0.001, respectively); HDL and NT proBNP were elevated significantly; HbA1C, GLU, WBC, CRP, ALT, AST, TGA, SBP, DBP and HR were significantly decreased; FRS reduced significantly (5.1 ± 6.0% vs. 3.7 ± 5.9%, P <0.001). QoL SF-36 improved significantly in all parameters (P <0.001). Serum GAL-3 and ETP levels reduced significantly (5.23 ± 1.96 ng/mL vs. 2.37 ± 1.72 ng/mL, P <0.001; 0.009 ± 0.003 ng/mL vs. 0.006 ± 0.004 ng/mL, P <0.001, respectively). No pre- and postoperative differences in serum FABP4, Apelin and Adiponectin levels (4.36 ± 1.98 ng/mL vs. 4.31 ± 2.77 ng/mL, P = 0.935; 50.74 ± 7.47 ng/mL vs. 49.56 ± 8.70 ng/mL, P = 0.437; 3.97 ± 0.65 ng/mL vs. 3.79 ± 1.12 ng/mL, P = 0.401, respectively) were observed. CMR-derived LVGLS, LVEF and MAPSE improved (−16.0 ± 3.1% vs. −18.6 ± 3.8%, P = 0.003; 57.5 ± 4.3% vs. 59.3 ± 4.5%, P = 0.021; 11.7 ± 2.9 mm vs. 14.1 ± 4.4 mm, P = 0.004, respectively). LVM, LVESV, LVCO, LVEDD and LVESD were significantly decreased (93.3 ± 17.8 g vs. 78.9 ± 13.0 g, P <0.001; 66.8 ± 16.8 ml vs. 60.4 ± 18.1 ml, P = 0.003; 6.5 ± 1.2 ml/min vs. 5.3 ± 1.0 ml/min, P <0.001; 49.2 ± 5.5 mm vs. 46.5 ± 4.6 mm, P = 0.001; 32.9 ± 6.0 mm vs. 30.5 ± 4.8 mm, P <0.001). LVEDVI and LVESVI were significantly increased (68.8 ± 13.8 ml/m2 vs. 78.1 ± 12.6 ml/m2, P <0.001; 29.7 ± 6.5 ml/m2 vs. 32.1 ± 8.1 ml/m2, P = 0.018). CONCLUSION: LSG, reverses obesity-induced cardiomyopathy by leading to a significant improvement in cardiovascular structure and function through effective weight loss in obese patients, coniderably reducing cardiovascular risk and improving the individual's quality of life. Keywords: Biomarker, Cardiac MRI, Laparoscopic Sleeve Gastrectomy, Myocardial Strain, Obesity