Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery - 20/08/11

Doi : 10.1016/j.amjmed.2008.06.033

Joshua G. Leichman, MD ^a, Erik B. Wilson, MD ^b, Terry Scarborough, MD ^b, David Aguilar, MD ^a, Charles C. Miller, PhD ^c, Sherman Yu, MD ^b, Mohamed F. Algahim, BSc ^a, Manuel Reyes, MD ^a, Frank G. Moody, MD ^b, Heinrich Taegtmeyer, MD, DPhil ^a,^⁎
^a Department of Internal Medicine, The University of Texas Health Science Center at Houston
^b Department of Surgery, The University of Texas Health Science Center at Houston
^c Department of Cardiovascular and Thoracic Surgery, The University of Texas Health Science Center at Houston

Requests for reprints should be addressed to Heinrich Taegtmeyer, MD, DPhil, University of Texas Houston Medical School, Department of Medicine/Cardiology, 6431 Fannin, MSB 1.246, Houston, TX 77030

Abstract

Objective

The study objective was to define muscle metabolic and cardiovascular changes after surgical intervention in clinically severe obese patients.

Methods

Obesity is a state of metabolic dysregulation that can lead to maladaptive changes in heart and skeletal muscle, including insulin resistance and heart failure. In a prospective longitudinal study, 43 consecutive patients underwent metabolic profiling, skeletal muscle biopsies, and resting echocardiograms at baseline and 3 and 9 months after bariatric surgery.

Results

Body mass index decreased (mean changes, 95% confidence interval [CI]): 7.7 kg/m² (95% CI, 6.70-8.89) at 3 months and 5.6 kg/m² (95% CI, 4.45-6.80; P<.0001) at 9 months after surgery, with restoration of insulin sensitivity and decreases in plasma leptin at the same time points. Concurrent with these changes were dramatic decreases in skeletal muscle transcript levels of stearoyl coenzyme-A desaturase and pyruvate dehydrogenase kinase-4 at 3 and 9 months (P<.0001, for both) and a significant decrease in peroxisome proliferation activated receptor-⍺–regulated genes at 9 months. Left ventricular relaxation impairment, assessed by tissue Doppler imaging, normalized 9 months after surgery.

Conclusion

Weight loss results in the reversal of systemic and muscle metabolic derangements and is accompanied by a normalization of left ventricular diastolic function.

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Keywords : Bariatric surgery, Echocardiography, Leptin, Metabolism, Obesity, Pyruvate dehydrogenase kinase-4, Stearoyl Co-A desaturase

Plan

Materials and Methods

Subject Selection

Study Protocol

Surgery

Patient Enrollment and Follow-up

Biopsies

Histology

Quantitative Reverse Transcriptase Polymerase Chain Reaction

Statistical Analyses

Results

Preoperative Findings

Postoperative Changes

Impact of the Type of Surgery on Outcomes

Discussion

Skeletal Muscle Histology

Skeletal Muscle Gene Expression

Left Ventricular Diastolic Function

Limitations

Conclusions

	Supported by the National Heart, Lung, and Blood Institute of the US Public Health Service (R01HL73162 and M01 RR02558). None of the authors of this work have any financial conflicts of interest to disclose. All authors had access to the data and a role in writing the article.
	Clinical Trials Registry: ClinicalTrials.gov Identifier: NCT00178633; www.clinicaltrials.gov