Cardiac structure and function before and after bariatric surgery: a clinical overview

Lascaris, Bianca; Pouwels, Sjaak; Houthuizen, Patrick; Dekker, Lukas; Nienhuijs, Simon W.; Bouwman, R. Arthur; Buise, Marc P.

doi:10.1111/cob.12278

Cited by 19 publications

(9 citation statements)

References 79 publications

(376 reference statements)

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“…Evidence suggests that higher maternal BP in the first trimester of pregnancy is associated with a higher risk of hypertensive disorders later on 32 , therefore the lower BP found in postbariatric women may provide a plausible explanation for the reduced rates of hypertension and PE reported in this population 19,33 . In this study, CO increased with gestation in both groups, reflecting physiological pregnancy changes 10 ; however, in the postbariatric pregnant group, lower SV and HR resulted in lower CO, as observed in postbariatric individuals outside the context of pregnancy 29,34 .…”

Section: Discussionsupporting

confidence: 45%

Effect of bariatric surgery on maternal cardiovascular system

Patel

Borrelli

Patey

et al. 2023

Ultrasound in Obstet & Gyne

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Objective Bariatric surgery is a successful treatment for sustainable weight loss and has been associated with improvement in cardiovascular function. Pregnancy after bariatric surgery is becoming increasingly common; however, little is known about the maternal cardiovascular system postsurgery. The aim of this study was to investigate maternal cardiovascular adaptation to pregnancy in women with previous bariatric surgery, compared with that in women with no history of weight‐loss surgery and an early‐pregnancy body mass index (BMI) similar to the presurgery BMI of the postbariatric women. Methods This was a prospective, observational, longitudinal study conducted from April 2018 to June 2020 including 30 pregnant women who had undergone bariatric surgery and 30 who had not, matched for presurgery BMI. Participants were seen at three timepoints during pregnancy: 12–14, 20–24 and 30–32 weeks' gestation. At all visits, maternal blood pressure (BP) was measured and cardiac geometry and function were assessed using two‐dimensional (2D) transthoracic echocardiography. On a subset of patients (15 in each group), 2D speckle tracking was performed to assess global longitudinal and circumferential strain. Offline analysis was performed, and multilevel linear mixed‐effects models were used for all comparisons. Results Compared with the no‐surgery group, and across all trimesters, pregnant women with previous bariatric surgery had lower BP, heart rate and cardiac output and higher peripheral vascular resistance (P < 0.01 for all). Similarly, the postbariatric group demonstrated more favorable cardiac geometry and diastolic indices, including lower left ventricular mass, left atrial volume and relative wall thickness, together with higher E‐wave/A‐wave flow velocity across the mitral valve and higher mitral velocity (E′) at the lateral and medial annulus on tissue Doppler imaging (P < 0.01 for all). There was no difference in ejection fraction, although global longitudinal strain was lower in postbariatric women (P < 0.01), indicating better systolic function. Conclusion Our findings indicate better maternal cardiovascular adaptation in women with previous bariatric surgery compared with presurgery BMI‐matched pregnant women with no history of weight‐loss surgery. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionsupporting

confidence: 45%

Effect of bariatric surgery on maternal cardiovascular system

Patel

Borrelli

Patey

et al. 2023

Ultrasound in Obstet & Gyne

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“…The independent associations of higher VAT and lower CRF with subclinical abnormalities in LV contractility highlight their potential role as modifiable targets for HF prevention [ 44 , 45 ]. Observational studies of individuals who have undergone bariatric surgery suggest that substantial weight loss can reverse pathological cardiac remodeling and reduce risk of incident HF[ 46 , 47 ]. More recently, findings from the Look AHEAD trial have demonstrated that greater loss of overall and central adiposity with lifestyle interventions is associated with lower risk of HF [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

Kondamudi

Thangada

Patel

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. Methods Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. Results The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: − 0.15, P < 0.001). Conclusions VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.

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“…With increments in adipose tissue and its vascular bed size in the case of overweight or obesity, as a compensatory mechanism, the sympathetic and renin-angiotensin-aldosterone (RAA) systems are activated to drive cardiovascular system overload for meeting the metabolic demands of extra adipose tissue. Long-standing overweight leads to cardiac volume- and pressure-overload, and higher cardiac output and blood pressure via activation of sympathetic and RAA systems, consequently causing myocardial fibrosis, ventricular maladaptive hypertrophy and enlargement with cardiac dysfunction, and increase of cardiovascular events and mortality 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Resultantly, hypoventilation, obstructive sleep apnea, hypoxia, hypercapnia and respiratory acidosis can then occur 22 . This chronic hypoxia and hypercapnia cause sympathetic-RAA system activation, vasoconstriction and hypertension with consequent overweight- or obesity-related cardiac geometric remodeling and dysfunction 20,22 . Additionally, accumulated adipose tissue can secrete RAA components, which can activate sympathetic and RAA systems, leading to adverse cardiac dysfunction 23,24 .…”

Section: Discussionmentioning

confidence: 99%

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Overweight and obesity are associated with cardiac adverse structure remodeling in Chinese elderly with hypertension

Liu

Laukkanen

et al. 2019

Sci Rep

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There is limited information on the association of overweight and obesity with cardiac remodeling in elderly population. Therefore, we investigated whether overweight and obesity are associated with cardiac geometric structures and function in Chinese elderly. A total of 1183 hospitalized patients (aged 65–99 years) with primary hypertension were collected retrospectively in a cross-sectional study, and divided into underweight, normal weight, overweight and obesity patient groups according to their body mass index (BMI). Cardiac echocardiographic parameters were compared between the groups. BMI was 17.2 ± 1.2, 21.4 ± 1.2, 25.1 ± 1.2, 30.2 ± 2.6 kg/m2 in underweight, normal weight, overweight and obesity groups respectively. Aortic and left atrial diameter, interventricular septal and left ventricular (LV) posterior wall thickness, LV end-diastolic and end-systolic diameter, and indexed LV mass, and prevalence of E/A reversal were higher, while LV ejection fraction and fractional shortening were lower in elderly with overweight or obesity, as compared with whose with underweight or normal weight separately (All P < 0.05). However, multivariable regression analysis showed that overweight and obesity are independently related to increased LV wall thickness, end-diastolic diameter and mass (All P < 0.05). In conclusions, this study demonstrates that overweight and obesity are associated with increased LV wall thickness, end-diastolic diameter and mass in Asian elderly.

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Cardiac structure and function before and after bariatric surgery: a clinical overview

Cited by 19 publications

References 79 publications

Effect of bariatric surgery on maternal cardiovascular system

Effect of bariatric surgery on maternal cardiovascular system

Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

Overweight and obesity are associated with cardiac adverse structure remodeling in Chinese elderly with hypertension

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