Anatomical and Functional Alterations of the Heart in Morbid Obesity. Changes After Bariatric Surgery

Luaces, María; Cachofeiro, Victoria; García-Muñoz-Najar, Alejandro; Medina, Manuel; González, Noemí; Cáncer, Emilia; Rodríguez-Robles, A.; Cánovas, Gloria; Antequera-Pérez, Alfonso

doi:10.1016/j.rec.2011.06.018

Cited by 43 publications

(46 citation statements)

References 24 publications

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“…The heart adapts to obesity through remodelling, which is a process that can involve left ventricular hypertrophy and dilation, as well as atrial changes [5][6][7]. These changes can affect cardiac function and finally initiate the development of heart failure.…”

Section: Introductionmentioning

confidence: 99%

The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients

Luaces¹,

Martínez‐Martínez²,

Medina³

et al. 2012

Nephrology Dialysis Transplantation

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Background. Cardiac adaptation to obesity includes both structural and functional alterations in the heart. The kidneys also suffer the consequence of excessive increase of body weight. This study aims to assess the functional, cardiac and renal changes in a cohort of morbidly obese patients, as well as changes after bariatric surgery-the last therapeutic option for these patients. Methods. Patients referred for bariatric surgery were prospectively included. In each case, transthoracic echocardiography and a blood test were performed before the procedure and repeated 1 year after surgery. The estimation of the glomerular filtration rate (GFR) was addressed by the Cockroft-Gault lean body weight formula. Results. Sixty-one patients completed the 1-year followup. Of these, 81.9% were female. The mean age was 41.1 ± 9.8 years and the mean body mass index was 47.4 ± 5 kg/m 2 , decreasing to 30.5 ± 5.07 kg/m 2 after the procedure. Before surgery, the estimated GFR was 92.7 ± 25.4 mL/min, with hyperfiltration being present in 14.8% of patients, whereas an impaired GFR was detected in 8.3%. Patients showed preserved systolic function and cardiac remodelling. Diastolic function was abnormal in 27.9% of patients. At the 1-year follow-up, favourable changes in the left ventricular geometry and related haemodynamic status were observed. There was no significant change in the estimated GFR in the overall group, although hyperfiltration was ameliorated in 9.8% and a poor GFR was improved in 3.3.%. The improvement was not associated with changes in either blood pressure or the BMI. However, in this group of patients the amelioration of the GFR was associated with an increased stroke volume and improvement in diastolic function. Conclusions. In morbidly obese patients, GFR is usually normal and only a small percentage of them show hyperfiltration or a reduced GFR. Bariatric surgery has a favourable impact on renal function in only a reduced group of patients who also experience an improvement in cardiac performance.

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Section: Introductionmentioning

confidence: 99%

The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients

Luaces¹,

Martínez‐Martínez²,

Medina³

et al. 2012

Nephrology Dialysis Transplantation

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“…[1][2][3] In patients with DCM, these hemodynamic changes produce impairment in the systolic left ventricular function and a larger heart dilatation. In the recent literature there is some evidence about the positive impact of BS on specific cases of heart disease as DCM.…”

Section: Discussionmentioning

confidence: 99%

Improvement of Ventricular Ejection Fraction after Bariatric Surgery in Obese Patients with Dilated Cardiomyopathy

Tomás¹,

Lusilla²,

Burneo³

et al. 2015

Obes Res Open J

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Case Report ABSTRACTMorbid obesity has been considered a contraindication for cardiac transplantation in some patients with Dilated cardiomyopathy (DCM). However, the positive effect of bariatric surgery on this population, with improvement in Ventricular Ejection Fraction (VEF), could even avoid the necessity of a cardiac transplant. Obesity produces cardiac dysfunction and weight loss operations can partially revert it.The impact of bariatric surgery among people with DCM has been studied in two patients with morbid obesity. Both male patients suffered from DCM with a VEF less than 27%, and other co-morbidities. Their Body Mass Index (BMI) was 44 kg/m 2 and 37 kg/m 2 , respectively. They underwent a sleeve gastrectomy and reached a BMI of 28 kg/m 2 , 18 months after the operation, with more than 10% improvement in their VEF. The second patient had a gastric leak, due a stapler failure, and finally underwent an uneventful total gastrectomy after unsuccessful endoscopic procedures.In conclusion, bariatric surgery offers a significant benefit for obese patients with DCM and should be considered by cardiologists as other therapeutic approach when other weight loss strategies had failed. CASE REPORTSCase 1: A 54-year-old male with Sleep Apnea Syndrome (SAS), Diabetes Mellitus (DM) type 2, hypertension, Morbid Obesity (MO) and Dilated cardiomyopathy (DCM) was referred to our hospital for bariatric surgery. In addition, the preoperative cardiac ultrasound showed a Ventricular Ejection Fraction (VEF) of 24%. He had a Body Mass Index (BMI) of 41 kg/m 2 and underwent an uneventful Sleeve Gastrectomy (SG). Three years after the surgical procedure, the patient co-morbidities and quality of life have improved, and the cardiac ultrasound confirmed an increase of his VEF from 24% to 36% ( Figure 1A-1B).

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“…Most studies have shown a decrease in LV diastolic chamber size and wall thickness after substantial weight loss [30,31] [32]. These changes were more closely related to change in weight than to concomitant change in blood pressure.…”

Section: Pathophysiologic Evidencementioning

confidence: 99%

“…Many studies demonstrate that weight reduction may have a beneficial effect on LV geometry [30]. Most studies have shown a decrease in LV diastolic chamber size and wall thickness after substantial weight loss [30,31] [32].…”

Section: Pathophysiologic Evidencementioning

confidence: 99%

Reducing the risk of heart failure exacerbation by bariatric surgery in obese patients

Mohajer

Shimada

2016

Expert Review of Endocrinology & Metabolism

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Anatomical and Functional Alterations of the Heart in Morbid Obesity. Changes After Bariatric Surgery

Cited by 43 publications

References 24 publications

The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients

The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients

Improvement of Ventricular Ejection Fraction after Bariatric Surgery in Obese Patients with Dilated Cardiomyopathy

Reducing the risk of heart failure exacerbation by bariatric surgery in obese patients

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