Preventive cardiology
Effects of Weight Loss After Bariatric Surgery on Epicardial Fat Measured Using Echocardiography

https://doi.org/10.1016/j.amjcard.2006.12.042Get rights and content

Epicardial fat assessed using echocardiography is associated with abdominal visceral adipose tissue and cardiovascular risk factors. Because of its location, epicardial fat may directly affect the coronary vasculature and myocardium through local secretion of bioactive molecules. This study examines the effects of weight loss after bariatric surgery on epicardial adipose tissue in patients with severe obesity. Clinical data and echocardiograms of 23 patients with severe obesity who had echocardiograms recorded before and 8.3 ± 3.7 months after undergoing bariatric surgery were retrospectively reviewed. Epicardial fat thickness was measured as the hypoechoic space anterior to the right ventricle in both the parasternal long- and short-axis views, and an average was obtained. At baseline, patients had increased epicardial fat compared with normal-weight controls matched for age, gender, and ethnicity (5.3 ± 2.4 vs 3.0 ± 1.1 mm, p <0. 001). Epicardial fat thickness was associated with the patient’s initial weight in severely obese patients (r = 0.51, p = 0.011). Patients lost an average of 40 ± 14 kg after surgery. Epicardial fat thickness decreased from 5.3 ± 2.4 to 4.0 ±1.6 mm (p = 0.001). Change in epicardial fat correlated with initial epicardial fat thickness measured using echocardiography (r = 0.71, p <0.001). In conclusion, epicardial fat thickness decreases in severely obese patients who have substantial weight loss after bariatric surgery. Measuring epicardial fat thickness using echocardiography may be useful to monitor visceral fat loss with weight reduction therapies.

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Subjects

We retrospectively reviewed clinical data and echocardiograms for 23 patients with severe obesity who had undergone bariatric surgery for standard indications (body mass index [BMI] >40 kg/m2 or BMI >35 kg/m2 plus an additional co-morbidity) and had echocardiograms recorded before and after surgery. Seventeen of these patients had volunteered to undergo repeated echocardiography as subjects in a previously reported study of the effects of weight loss on cardiac function.16 The remaining 6 had

Results

At baseline, obese patients were 221 ± 46% of their IBW and had 86 ± 41 kg of excess weight. In obese patients, 19 underwent open or laparoscopic long-limb Roux-en-Y gastric bypass, 2 underwent laparoscopic vertical band gastroplasty, and 1 underwent laparoscopic adjustable gastric banding. Repeated echocardiograms were obtained 8.3 ± 3.7 months after surgery. All baseline and follow-up echocardiographic images were considered satisfactory for measurement of epicardial fat. Intraobserver

Discussion

In this study, we observed a decrease in epicardial fat thickness assessed using echocardiography in most patients with severe obesity who had substantial weight loss after bariatric surgery. The magnitude of this decrease in epicardial fat was related to initial epicardial fat thickness. An additional finding is that subjects with extreme obesity have increased echocardiographically measured epicardial fat compared with age- and gender-matched normal weight controls. The amount of epicardial

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This work was supported by the Schecter Family Foundation, Miami, Florida.

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