Long-Term Changes in Cardiac Structure and Function Following Bariatric Surgery

• Published in: Journal of the American College of Cardiology Vol. 80; no. 16; pp. 1501 - 1512
• Main Authors: Sorimachi, Hidemi, Obokata, Masaru, Omote, Kazunori, Reddy, Yogesh N.V., Takahashi, Naoki, Koepp, Katlyn E., Ng, Arnold C.T., Rider, Oliver J., Borlaug, Barry A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 18.10.2022
• Subjects: Bariatric Surgery; cardiac function; cardiac structure; Cardiovascular; Glucose; heart failure; Heart Ventricles; Humans; obesity; Pericardium; Ventricular Function, Left - physiology; Ventricular Remodeling; Weight Loss; heart failure; bariatric surgery; RV; SAT; VAT; LV; HFpEF; RWT; GLS; eFS; BW; LA; WL; cardiac structure; EAT; FWLS; cardiac function; obesity; HF; BMI; body weight; heart failure with preserved ejection fraction; subcutaneous adipose tissue; left ventricular; visceral adipose tissue; right ventricular; body mass index; weight loss; left atrial; global longitudinal strain; free wall longitudinal strain; endocardial fractional shortening; epicardial adipose tissue; relative wall thickness
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2022.08.738

Studies with short-term follow-up have demonstrated favorable effects of weight loss (WL) on the heart, but little information is available regarding long-term effects or effects of visceral fat reduction. The purpose of this study was to evaluate the effects of long-term WL following bariatric surgery on cardiac structure, function, ventricular interaction, and body composition, including epicardial adipose thickness and abdominal visceral adipose tissue (VAT). A total of 213 obese patients underwent echocardiography before and >180 days following bariatric surgery. Abdominal VAT area was measured by computed tomography in 52 of these patients. After 5.3 years (IQR: 2.9-7.9 years), body mass index (BMI) decreased by 22%, with favorable reductions in blood pressure, fasting glucose, and left ventricular (LV) remodeling in the full sample. In the subgroup of patients with abdominal computed tomography, VAT area decreased by 30%. In all subjects, epicardial adipose thickness was reduced by 14% (both P < 0.0001) in tandem with reductions in ventricular interdependence. LV and right ventricular longitudinal strain improved following WL, but left atrial (LA) strain deteriorated, while LA volume and estimated LA pressures increased. In subgroup analysis, LV wall thickness and strain correlated more strongly with VAT than BMI at baseline, and reductions in LV mass following surgery were correlated with decreases in VAT, but not BMI. In this observational study, weight loss following bariatric surgery was associated with epicardial fat reduction, reduced ventricular interaction, LV reverse remodeling, and improved longitudinal biventricular mechanics, but LA myopathy and hemodynamic congestion still progressed. Reduction in visceral fat was associated with favorable cardiac effects, suggesting this might be a key target of WL interventions. [Display omitted]