alexa Impact of bariatric surgery on N-terminal fragment of the prohormone brain natriuretic peptide and left ventricular diastolic function.


Translational Medicine

Author(s): Martin J, Bergeron S, Pibarot P, Bastien M, Biertho L,

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Abstract BACKGROUND: Obesity is often associated with left ventricular (LV) diastolic dysfunction (DD). Elevated N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) is considered a biomarker of LV dysfunction. Weight loss induced by bariatric surgery may improve LV DD, but conflicting results regarding NT-proBNP levels have been reported. Our objective was to determine the impact of bariatric surgery-induced weight loss on NT-proBNP levels and LV DD. METHODS: Seventy (70) patients were evaluated before and 6 and 12 months following a biliopancreatic diversion with duodenal switch (BPD-DS), and 33 subjects were followed as controls at baseline and 6 and 12 months later. Blood was collected for NT-proBNP measurement, and LV diastolic function was assessed with echocardiography. RESULTS: Among the 103 severely obese patients, 82\% presented some degree of LV DD. Systolic function was preserved in all subjects. Along with significant weight loss, LV DD significantly improved (P < 0.001) in the BPD-DS group, whereas there was no change in the control group. NT-proBNP levels decreased over time in the control group (P = 0.016) and increased in subjects following BPD-DS (baseline vs 6-month vs 12-month follow-up: 51.8 ± 62.8 vs 132.0 ± 112.9 vs 143.3 ± 120.4 pg/mL; P < 0.001). The most significant associations with changes in NT-proBNP levels were improvements in the metabolic profile. CONCLUSIONS: In severely obese patients, NT-proBNP levels decrease with sustained obesity for 1 year. Despite significant improvements in LV DD following bariatric surgery, NT-proBNP levels increase. These results suggest that monitoring NT-proBNP levels following bariatric surgery may be misleading regarding LV DD and symptoms of dyspnea. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. This article was published in Can J Cardiol and referenced in Translational Medicine

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