Bariatric Surgery Improves Cardiac Remodeling and Function in Adults With Preserved Left Ventricular Ejection Fraction.

BACKGROUND

Obesity is a risk factor for heart failure. Surgical treatment of obesity may help prevent heart failure.

OBJECTIVES

We examine the effect of bariatric surgery on cardiac remodeling and function in adults with preserved left ventricular (LV) ejection fraction.

METHODS

Thirty-eight individuals with severe obesity (body mass index ≥35 kg/m2) and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch), and 34 individuals with obesity managed medically were included. Conventional echocardiography and speckle tracking echocardiography were obtained at baseline and 12-month follow-up.

RESULTS

The mean age of participants (75% female) was 48.5 ± 8.3 years and body mass index 46.4 ± 3.7 kg/m2. Bariatric surgery led to marked weight reduction (percentage of total weight loss 36.7% ± 7.1%) and significant improvements in obesity-related metabolic conditions/comorbidities. Bariatric surgery was associated with a significant reduction in LV mass and LV hypertrophy (P < 0.001), improvement in LV diastolic function parameters (P < 0.01), and improvement in subclinical systolic function (LV global longitudinal strain, 16.3% ± 2.5% vs 18.5% ± 1.3%, P < 0.05). Preoperative abnormalities of subclinical cardiac function were highly prevalent (79%) and normalized in 70% of subjects after surgery. Subjects with obesity managed medically remain with a significant burden of comorbidities and a number (38%) worsened their subclinical systolic function during the follow-up (P < 0.05).

CONCLUSIONS

Bariatric surgery may be an effective and safe way to prevent and/or reverse obesity-related cardiac abnormalities. Larger prospective studies are warranted to confirm these observations and determine their long-term clinical implications.