Effect of bariatric surgery on cardiac structure and function in obese patients: Role of the renin-angiotensin system

Anna Oliveras; Lluís Molina; Albert Goday; Laia Sans; Marta Riera; Susana Vazquez; David Benaiges; Ana Marina Granados; José Manuel Ramon; Julio Pascual

doi:10.1111/jch.14129

Effect of bariatric surgery on cardiac structure and function in obese patients: Role of the renin-angiotensin system

J Clin Hypertens (Greenwich). 2021 Jan;23(1):181-192. doi: 10.1111/jch.14129. Epub 2020 Dec 17.

Authors

Anna Oliveras^{1

2

3

4}, Lluís Molina^{2

4

5}, Albert Goday^{2

3

6

7}, Laia Sans^{1

2}, Marta Riera^{2

4}, Susana Vazquez^{1

2}, David Benaiges^{2

3

6}, Ana Marina Granados⁸, José Manuel Ramon^{2

9}, Julio Pascual^{1

2

3

4}

Affiliations

¹ Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Barcelona.
² IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
³ Universitat Autònoma de Barcelona, Barcelona, Spain.
⁴ Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, Madrid, Spain.
⁵ Cardiology Department, Hospital Universitari del Mar, Barcelona.
⁶ Endocrinology Department, Hospital Universitari del Mar, Barcelona.
⁷ Medicine Department, Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Madrid, Spain.
⁸ Dialysis Clinic of Burjassot, València, Spain.
⁹ General Surgery Department, Hospital Universitari del Mar, Barcelona, Spain.

Abstract

Echocardiographic alterations have been described in obesity, but their modifications after bariatric surgery (BS) and mechanisms are little known, mostly in normotensive patients. We aimed to analyze cardiac changes 1 year post-BS and to explore possible mechanisms. A cohort of patients with severe obesity (58% normotensives) were prospectively recruited and examined before surgery and after 12 months. Clinical and echocardiographic data, 24 h BP, renin-angiotensin-aldosterone system (RAAS) components, cytokines, and inflammatory markers were analyzed at these two time points. Overall reduction in body weight was mean (IQR) = 30.0% (25.9-33.8). There were statistically significant decreases in left ventricle mass index^2.7 (LVMI)^2.7 , septum thickness (ST), posterior wall thickness (PWT), relative wall thickness (RWT), and E/e', both in the whole cohort and in patients without RAAS blockers (p ≤ .04 for all). Plasma renin activity (PRA) decreased from (median, IQR) = 0.8 (0.3;1.35) to 0.4 (0.2;0.93) ng/ml/h, plasma aldosterone from 92 (58.6;126) to 68.1 (56.2;83.4) ng/dl, and angiotensin-converting enzyme (ACE)-2 activity from 7.7 (5.7;11.8) to 6.8 (5.3;11.2) RFU/µl/h, p < .05. The body weight loss correlated with a decrease in both 24 h SBP and 24 h DBP (Pearson's coefficient 0.353, p = .022 and 0.384, p = .012, respectively). Variation (Δ) of body weight correlated with ΔE/e' (Pearson's coeff. 0.414, p = .008) and with Δ lateral e' (Pearson's coeff. = -0.363, p = .018). Generalized linear models showed that ΔPRA was an independent variable for the final (12-months post-BS) LVMI^2.7 (p = .028). No other changes in cardiac parameters correlated with ΔBP. In addition to the respective baseline value, final values of PWT and RWT were dependent on 12-month Δ of PRA, ACE, and ACE/ACE2 (p < .03 for all). We conclude that there are cardiac changes post-BS in patients with severe obesity, normotensives included. Structural changes appear to be related to modifications in the renin-angiotensin axis.

Trial registration: ClinicalTrials.gov NCT03115502.

Keywords: angiotensin-converting enzyme 2; bariatric surgery; blood pressure; echocardiography; renin-angiotensin axis; severe obesity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aldosterone
Bariatric Surgery*
Blood Pressure
Humans
Hypertension*
Obesity / complications
Obesity / surgery
Renin
Renin-Angiotensin System

Substances

Aldosterone
Renin

Associated data

ClinicalTrials.gov/NCT03115502