Bariatric Surgery Improves Cardiac Remodeling and Function in Adults With Preserved Left Ventricular Ejection Fraction.

BACKGROUND: Obesity is a risk factor for heart failure. Surgical treatment of obesity may help prevent heart failure. OBJECTIVES: We examine the effect of bariatric surgery on cardiac remodeling and function in adults with preserved left ventricular (LV) ejection fraction. METHODS: Thirty-eight individuals with severe obesity (body mass index ≥35 kg/m2) and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch), and 34 individuals with obesity managed medically were included. Conventional echocardiography and speckle tracking echocardiography were obtained at baseline and 12-month follow-up. RESULTS: The mean age of participants (75% female) was 48.5 ± 8.3 years and body mass index 46.4 ± 3.7 kg/m2. Bariatric surgery led to marked weight reduction (percentage of total weight loss 36.7% ± 7.1%) and significant improvements in obesity-related metabolic conditions/comorbidities. Bariatric surgery was associated with a significant reduction in LV mass and LV hypertrophy (P < 0.001), improvement in LV diastolic function parameters (P < 0.01), and improvement in subclinical systolic function (LV global longitudinal strain, 16.3% ± 2.5% vs 18.5% ± 1.3%, P < 0.05). Preoperative abnormalities of subclinical cardiac function were highly prevalent (79%) and normalized in 70% of subjects after surgery. Subjects with obesity managed medically remain with a significant burden of comorbidities and a number (38%) worsened their subclinical systolic function during the follow-up (P < 0.05). CONCLUSIONS: Bariatric surgery may be an effective and safe way to prevent and/or reverse obesity-related cardiac abnormalities. Larger prospective studies are warranted to confirm these observations and determine their long-term clinical implications.