title: Effect of bariatric surgery on peripheral flow-mediated dilation and coronary microvascular function.
abstract: OBJECTIVE
  To assess the effects of bariatric surgery (BS) on peripheral endothelial function and on coronary microvascular dilator function.
  
  
  RESULTS
  We studied 50 morbidly obese patients (age 38 ± 9, 13 M) who underwent BS and 20 comparable obese controls (age 41 ± 11, 6 M) without any evidence of cardiovascular disease. Peripheral vascular dilator function was assessed by brachial artery diameter changes in response to post-ischemic forearm hyperaemia (flow-mediated dilation, FMD). Coronary microvascular function was assessed by measuring coronary blood flow (CBF) velocity response to i.v. adenosine and to cold pressor test (CPT) in the left anterior descending coronary artery by transthoracic Doppler echocardiography. The tests were performed at baseline and at 3-month follow-up. At baseline, FMD and CBF response to adenosine and CPT were similar in the 2 groups. Compared to baseline, FMD at follow-up improved significantly in BS patients (5.9 ± 2.7% to 8.8 ± 2.4%, p < 0.01), but not in controls (6.3 ± 3.2% vs. 6.4 ± 3.1%, p = 0.41). Similarly, a significant improvement of CBF response to adenosine (1.63 ± 0.47 to 2.45 ± 0.57, p < 0.01) and to CPT (1.43 ± 0.26 to 2.13 ± 0.55, p < 0.01) was observed in BS patients but not in controls (1.55 ± 0.38 vs. 1.53 ± 0.37, p = 0.85; and 1.37 ± 0.26 vs. 1.34 ± 0.21, p = 0.48, respectively). The favourable vascular effects of BS were similar independently of the presence and changes of other known cardiovascular risk factors and of basal values and changes of serum C-reactive protein levels.
  
  
  CONCLUSIONS
  Our data show that, in morbidly obese patients, together with peripheral endothelial function, BS also improves coronary microvascular function. These effects suggest global improvement of vascular function which can contribute significantly to the reduction of cardiovascular risk by BS reported in previous studies.
authors.affiliation: Dipartimento di Medicina Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Nerla
authors.forename: P
authors.initials: P
authors.lastname: Tarzia
authors.forename: A
authors.initials: A
authors.lastname: Sestito
authors.forename: A
authors.initials: A
authors.lastname: Di Monaco
authors.forename: F
authors.initials: F
authors.lastname: Infusino
authors.forename: D
authors.initials: D
authors.lastname: Matera
authors.forename: F
authors.initials: F
authors.lastname: Greco
authors.forename: R M
authors.initials: RM
authors.lastname: Tacchino
authors.forename: G A
authors.initials: GA
authors.lastname: Lanza
authors.forename: F
authors.initials: F
authors.lastname: Crea
mesh_terms: D000241:Adenosine; D000328:Adult; D050110:Bariatric Surgery; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation; D014665:Vasodilator Agents
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D000241:Adenosine