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Reversibility of Myocardial Metabolism and Remodeling in Morbidly Obese Patients Six Months after Bariatric Surgery.
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Reversibility of Myocardial Metabolism and Remodeling in Morbidly Obese Patients Six Months after Bariatric Surgery.

Diabetes Obes Metab. 2017 Dec 05;:

Authors: Hannukainen JC, Lautamäki R, Pärkkä J, Strandberg M, Saunavaara V, Hurme S, Soinio M, Dadson P, Virtanen KA, Grönroos T, Forsback S, Salminen P, Iozzo P, Nuutila P

Abstract
AIMS/HYPOTHESIS: To study myocardial substrate uptake, structure and function before and after bariatric surgery to clarify the interaction between myocardial metabolism and cardiac remodeling in morbid obesity.
METHODS: We studied 46 subjects (age 44±10 yrs, BMI 42±4 kg/m2), including 18 with type 2 diabetes before and six months after bariatric surgery and 25 healthy age-matched controls. Myocardial fasting free fatty acid uptake (MFAU) and insulin-stimulated glucose uptake (MGU) were measured using PET. Myocardial structure, function, triglyceride content (MTGC) and intrathoracic fat were measured with MRI and MRS.
RESULTS: Morbidly obese subjects, with or without type 2 diabetes, had cardiac hypertrophy, impaired myocardial function and substrate metabolism compared to controls. Surgery led to marked weight reduction and remission of type 2 diabetes in most of the subjects. Post-operatively, myocardial function and structure improved and myocardial substrate metabolism normalized. Intrathoracic fat, but not MTGC, was reduced. Before surgery, BMI and MFAU correlated with LV hypertrophy and BMI, age and intrathoracic fat mass were the main parameters associated with cardiac function. The improvement in whole-body insulin sensitivity correlated positively with the increase in MGU and the decrease in MFAU.
CONCLUSIONS/INTERPRETATION: In the present study, obesity and age, rather than myocardial substrate uptake, were the causes of cardiac remodeling in morbidly obese subjects with or without type 2 diabetes. Cardiac remodeling and impaired myocardial substrate metabolism are reversible after surgically induced weight loss and amelioration of type 2 diabetes.

PMID: 29206339 [PubMed - as supplied by publisher]