Subclinical left ventricular dysfunction in severe obesity and reverse cardiac remodeling after bariatric surgery

Abstract

Aim: Obesity is associated with an increased cardiovascular risk. This study aimed to assess the role of echocardiography in the early detection of subclinical cardiac abnormalities in a cohort of obese patients with a preserved ejection fraction (EF) undergoing bariatric surgery. Methods and Results: Forty consecutive severely obese patients (body mass index≥35 kg/m2) referring to our center for bariatric surgery were enrolled in this prospective cohort study. Despite a baseline EF of 61% ± 3%, almost half patients (43%) had a systolic dysfunction (SD) defined as global longitudinal strain (GLS)>−18%, and most of them (60%) had left ventricular hypertrophy (LVH) or concentric remodeling (CR). At 10-months after surgery, body weight decreased from 120 ± 15 kg to 83 ± 12 kg, body mass index from 44 ± 5 kg/m 2 to 31 ± 5 kg/m 2 (both P < 0.001). Septal and left ventricular posterior wall thickness decreased respectively from 10 ± 1 mm to 9 ± 1 mm ( P = 0.004) and from 10 ± 1 mm to 9 ± 1 mm ( P = 0.007). All systolic parameters improved: EF from 61% ± 3% to 64% ± 3% ( P = 0.002) and GLS from −17% ± 2% to −20% ± 1% ( P < 0.001). Epicardial fat thickness reduction (from 4.7 ± 1 mm to 3.5 ± 0.7 mm, P < 0.001) correlated with the reduction of left atrial area ( P < 0.001 R = 0.35) and volume ( P = 0.02 R = 0.25). Following bariatric surgery, we observed a reduced prevalence of LVH/CR (before 60%, after 22%, P = 0.001) and a complete resolution of preclinical SD (before 43%, after 0%, P < 0.001). Moreover, a postoperative reduction of at least 30 kg correlated with regression of septal hypertrophy ( P < 0.001). Conclusions: Obese patients candidate to bariatric surgery have an high prevalence of preclinical SD and LVH/CR, early detectable with echocardiography. Bariatric surgery is associated with reverse cardiac remodeling; it might also have a preventive effect on atrial fibrillation occurrence by reducing its substrate.

Effect of bariatric surgery on maternal cardiovascular system

“…There was no difference in ejection fraction between the groups, however GLS was lower in postbariatric women, suggesting better systolic function. Diastolic indices were also more favorable in the postbariatric group, with higher E/A ratio and TDI-E lat and E med, and lower E/E ratio and left atrial volume, which is consistent with findings in non-pregnant individuals following bariatric surgery 7,30,37,38 .…”

Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function

“…There were no significant differences in age, sex, and BMI between the normal and impaired GLS groups. Previous studies have reported that GLS is impaired in aged, female, or overweight patients [ 5 , 6 ]. Furthermore, GLS reportedly declines with age without a significant decrease in LVEF [ 24 ].…”

“…In the general population without cardiovascular disease or traditional risk factors, the absolute GLS difference between men and women is >1%, and women have better (lower) GLS [ 5 ]. Obese candidates for bariatric surgery have a high prevalence of preclinical systolic dysfunction and LVH or concentric remodeling, which is detectable in the early stage with echocardiography [ 6 ]. The lack of correlation between these factors and impaired GLS in our cohort may be due to the small sample size.…”

“…Studies have reported that GLS is impaired in aged, female, and overweight patients. [ 5 , 6 ] Several diseases have been associated with impaired GLS, including hypertension (HT), diabetes mellitus (DM), renal insufficiency, cardiomyopathies, and valvular heart disease (VHD) [ 1 , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. In patients with HT, impaired GLS is reportedly associated with concentric and dilated LV hypertrophy (LVH) patterns, independent of demographic and clinical parameters [ 14 ].…”

Cardiac and Metabolic Effects of Bariatric Surgery Among Obese Patients in a Malaysian Tertiary Hospital: A 6-month Prospective Cohort Study

“…In a study done by Frea et al, in 2020 involving 40 patients who underwent bariatric surgery, there was an improvement in GLS 10 months after surgery. 24 In 2019, a meta-analysis of 7 randomized controlled trials examining the outcome of bariatric surgery versus medical treatment for type 2 diabetes mellitus showed that bariatric surgery is superior and has a more persistent effect on type 2 diabetes mellitus remission compared to medical management. 25 reported when necessary.…”