Effects of Bariatric Surgery on Cardiac Structure and Function: A Systematic Review and Meta-Analysis

Cuspidi, Cesare; Rescaldani, Marta; Tadić, Marijana; Sala, Carla; Grassı, Guıdo

doi:10.1093/ajh/hpt215

Cited by 101 publications

(63 citation statements)

References 47 publications

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“…In a study of 727 young-to-middle age, untreated subjects screened for stage 1 hypertension and followed up for 8 years, obesity was associated with both incident sustained hypertension and LVH. 29 There is also scattered evidence that reduction of body mass index has favorable effects on reduction of LVH 30,31 and that LVH is a distinctive characteristics in metabolic syndrome even in the absence of arterial hypertension. 32 In the context of a population of hypertensive patients, obesity is a deleterious condition, substantially increasing the chance to develop LVH.…”

Section: Discussionmentioning

confidence: 99%

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

et al. 2017

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L eft ventricular (LV) hypertrophy (LVH) is a marker of target organ damage in hypertension and helps stratifying cardiovascular risk.1,2 The effect of LVH on incident cardiovascular events is independent of conventional risk factors and of coronary artery disease. [3][4][5] In selected subsets of nondiabetic patients, LVH also precedes new onset of diabetes mellitus, 6 suggesting that hypertensive target organ damage might be also a marker of complex metabolic changes associated with the evolution of arterial hypertension.Prevention of the development of target organ damage should be, therefore, the main goal of management of arterial hypertension. 7,8 The most modifiable parameter to achieve this goal is the effective control of blood pressure (BP) using appropriate antihypertensive medications. There is no information on whether LVH could develop during antihypertensive regimen. However, we recently demonstrated that carotid plaque can develop in a specific patient phenotype, independently of optimal BP control. 10 In that study, we found that risk of incident carotid plaque was higher in older diabetic or smoker patients with chronic renal failure and higher initial intima-media thickness complex, suggesting that earlier antihypertensive management might be more beneficial to reduce and prevent target organ damage.In the present analysis, we evaluate whether LVH occurs during antihypertensive therapy and whether a specific phenotype can be identified at risk of incident LVH, in a large treated hypertensive population from a regional Italian registry. Methods Study PopulationHypertensive patients were selected from the Campania Salute Network (CSN) Registry. The CSN is an open registry collecting information from general practitioners and community hospitals networked with the Hypertension Research Center of the Federico Abstract-There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m 2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca ++ -channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients a...

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Section: Discussionmentioning

confidence: 99%

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

et al. 2017

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“…2 Finally, we and others have found that adolescents undergoing WLS had evidence of a pathologic impact of severe obesity on cardiac structure and physiology (ie, diastolic dysfunction and elevated cardiac workload). 27,30,31 …”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Factors in Severely Obese Adolescents

et al. 2015

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IMPORTANCE Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. OBJECTIVE To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children’s Hospital in Columbus, Ohio; Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio; Texas Children’s Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children’s Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. MAIN OUTCOMES AND MEASURES This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. RESULTS The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI, 1.26–2.03]; P < .01) and elevated blood pressure (adjusted relative risk = 1.48 [95% CI, 1.16–1.89]; P < .01) were more likely in adolescent boys compared with adolescent girls. White individuals were at greater risk of having elevated triglyceride levels (adjusted relative risk = 1.76 [95% CI, 1.14–2.72]; P = .01) but were less likely to have impaired fasting glucose levels (adjusted relative risk = 0.58 [95% CI, 0.38–0.89]; P = .01). CONCLUSIONS AND RELEVANCE Numerous CVD risk factors are apparent in adolescents undergoing weight-loss surgery. Increasing body mass index and male sex increase the relative risk of specific CVD risk factors. These data suggest that even among severely obese adolescents, recognition and treatment of CVD risk factors is important to help limit further progression of disease.

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“…Weight loss, however achieved, has been shown to result in improved LV systolic and diastolic function [31]. In a study of 261 patients with BMI ≥ 30 kg/m 2 who undertook a behavioural intervention programme including dietary restriction and exercise training, independent predictors of improvement in LV function were weight reduction, improvement in insulin resistance and absence of diabetes [32].…”

Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction in type II diabetes: a bittersweet, weighty problem, or both?

Leung

Wong

Durmush³

et al. 2016

Acta Diabetol

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Aims Weight loss in obese patients leads to improved left ventricular (LV) function. It is unclear whether improving glycaemic control has additional benefits to weight loss alone in patients with type 2 diabetes, or if benefits of weight loss are mediated through improving glycaemic control. This case–control study examined the incremental impact of these approaches on LV function. MethodsThree groups of age, gender, and baseline HbA1c-matched patients with type 2 diabetes and suboptimal glycaemic control were followed-up for 12 months. Group 1 patients did not improve HbA1c ≥ 1 % (10.9 mmol/mol) or lose weight. Group 2 improved HbA1c ≥ 1 % but did not lose weight. Group 3 improved HbA1c ≥ 1 % (10.9 mmol/mol) and lost weight. All patients underwent transthoracic echocardiogram at baseline and at follow-up.ResultsAt baseline, three groups were comparable in all clinical and metabolic parameters except Group 3 had highest body mass index. The three groups had similar echocardiographic parameters except Group 3 had the worst LV systolic function [global longitudinal strain (GLS)]. At follow-up, LV ejection fraction and diastolic function improved with a reduction in filling pressures in Group 2 and more so in Group 3. LV filling pressures in Group 1 increased. There was a significant improvement in GLS in Group 2 and more so in Group 3. Despite GLS being the worst in Group 3 at baseline, this was comparable between Groups 2 and 3 at follow-up.ConclusionsIn overweight patients with type 2 diabetes, weight loss and improved glycaemic control had additive beneficial effects on improving LV systolic and diastolic function.

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Effects of Bariatric Surgery on Cardiac Structure and Function: A Systematic Review and Meta-Analysis

Cited by 101 publications

References 47 publications

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

Cardiovascular Risk Factors in Severely Obese Adolescents

Cardiac dysfunction in type II diabetes: a bittersweet, weighty problem, or both?

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