Impact of Rapid Weight Loss after Bariatric Surgery in Systemic Inflammatory Response and Pulmonary Hemodynamics in Severely Obese Subjects with Pulmonary Hypertension

• Published in: Journal of the American College of Surgeons Vol. 236; no. 2; pp. 365 - 372
• Main Authors: Valera, Roberto J, Fonnegra, Cristina Botero, Cogollo, Vicente J, Sarmiento-Cobos, Mauricio, Rivera, Carlos, Lo Menzo, Emanuele, Szomstein, Samuel, Rosenthal, Raul J
• Format: Journal Article
• Language: English
• Published: United States 01.02.2023
• Subjects: Bariatric Surgery; Hemodynamics; Humans; Hypertension, Pulmonary - complications; Inflammation; Obesity - complications; Obesity - surgery; Prospective Studies; Retrospective Studies; Systemic Inflammatory Response Syndrome - complications; Weight Loss
• ISSN: 1072-7515; 1879-1190; 1879-1190
• DOI: 10.1097/XCS.0000000000000475

Pulmonary hypertension (PH) can be associated with obesity. The excessive production of proinflammatory mediators by dysfunctional adipocytes may enhance remodeling of the pulmonary vasculature and worsen pulmonary hemodynamics. This study aimed to describe the changes in pulmonary arterial pressures and systemic inflammation in patients with obesity with PH after bariatric surgery (BaS). In this retrospective cohort study, we compared patients with PH who underwent BaS from 2008 to 2018 at our institution (group 1) to a group of severely obese patients with PH (group 2). Echocardiographic right ventricular systolic pressure (RVSP) was used as an indirect measurement of pulmonary arterial pressures. Red blood cell distribution width (RDW) was used as a marker of systemic inflammation. A total of 40 patients were included, 20 per group. In group 1, the RVSP decreased from 44.69 ± 7.12 mmHg to 38.73 ± 12.81 mmHg (p = 0.041), and the RDW decreased from 15.22 ± 1.53 to 14.41 ± 1.31 (p = 0.020). In group 2, the RVSP decreased from 60.14 ± 18.08 to 59.15 ± 19.10 (0.828), and the RDW increased from 15.37 ± 1.99 to 15.38 ± 1.26 (0.983). For both groups, we found a positive correlation between RVSP and RDW changes, although the correlation was not statistically significant. Previous studies suggest BaS could be a safe and effective procedure to achieve weight loss in obese patients with PH, with an additional modest improvement in pulmonary hemodynamics. The results of this study reinforce this observation and suggest that such improvement could be related to a decrease in systemic inflammation. Further prospective studies with bigger samples are needed to better understand these findings.