Patients who underwent laparoscopic sleeve gastrectomy (LSG) showed significant decreases in epicardial fat thickness (EFT), according to a prospective studypublished inAnnals of Medicine.

Epicardial fat thickness is a marker for visceral fat deposition and increased thickness (fat between the pericardium and myocardium) has been linked to a higher risk of atherosclerosis, dyslipidemia, insulin resistance, and coronary artery disease. Thus, EFT can be viewed as an indicator of cardiovascular disease (CVD) in patients with obesity, the study authors noted. The study was designed to investigate the effects of weight loss following LSG on EFT and whether EFT decreases following surgery correlated with other clinical parameters.   

The prospective cohort analysis included 98 patients with morbid obesity (BMI ≥40) who underwent LSG from March 2013 to February 2017 and 70 matched patients with obesity who received conservative management.  


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None of the patients had poorly controlled diabetes, a high-risk profile of CVD, history of thromboembolic events, advanced heart failure, bleeding disorders, chronic kidney disease, organ failure, malignancy, psychiatric disorders, mental illness, and/or active infection at baseline.

Medical history was taken and a full physical examination was conducted. Lipid profile, blood glucose profile, glycated hemoglobin (HbA1c), homeostasis model assessment index for insulin resistance (HOMA-IR), liver function tests, and serum creatinine were recorded at baseline and 12-month follow-up.

Epicardial fat thickness was measured using standard 2D echocardiography in the parasternal aspect for 3 continuous cardiac cycles and perpendicular to the right ventricular free wall at baseline and 12-month follow-up by a researcher who was blinded to the study groups.

Study Outcomes

At 12-month follow-up, patients in the LSG group had significant lower values for body weight, BMI, mean arterial blood pressure, fasting blood glucose, fasting insulin, HbA1c, low-density lipoprotein (LDL), liver enzymes, and HOMA-IR compared with patients in the control group, the study authors noted.

“All patients had a significant drop in the left atrial diameter, end-systolic diameter, end-diastolic diameter, septum thickness, and post wall thickness,” the authors said. “On comparing the echocardiographic parameters at the end of follow-up, patients in the LSG group had significantly lower septum thickness and ejection fraction than the control arm.”

The patients who underwent LSG also showed a significant reduction in EFT at follow-up compared with patients in the control group. “In addition, the reduction in epicardial fat thickness correlated strongly with the degree of weight reduction at 12 months of follow-up,” the study authors reported.

The study authors concluded that LSG led to a statistically significant reduction in EFT 12 months after the operation and the decrease was more notable following LSG than conservative methods.

Reference

Salman A, Salman M, Soliman A, et al. Changes of epicardial fat thickness after laparoscopic sleeve gastrectomy: a prospective study.Ann Med. 2021;53(1): 523-530. doi:10.1080/07853890.2021.1903072.