Sleeve gastrectomy as a bridge to cardiac recovery - A retrospective comparative cohort study

Figure 1. Primary Outcomes: Changes in (A) LVEF (%), (B) NYHA Functional Class and (C) BMI (kg/m2), Following Sleeve Gastrectomy (Treatment, n = 20) in Matched Patients with HFrEF and Obesity Compared to Standard Care (Comparison, n = 40). Sample size for LVEF: Treatment (n=19) and Comparison (n=38). Data are presented as box plots showing the median and the range from minimum to maximum values, or as stacked bar charts showing the proportion of patients in each group. P-values were calculated using a mixed-effects model with repeated measures (REML). Significant differences were identified using Bonferroni correction for multiple comparisons, with p-values as follows: p < 0.001 (***), p < 0.01 (**), p < 0.05 (*), and p ≥ 0.05 (ns).

Figure 2. Changes in Cardiac Structure in Patients with HFrEF and Obesity Undergoing Sleeve Gastrectomy (Treatment) Versus Standard of Care (Comparison). Comparison of (A) Left Ventricular End-Diastolic Diameter (LVEDD, mm), (B) Left Ventricular End-Systolic Diameter (LVESD, mm), (C) Left Atrial (LA) Diameter (mm), (D) Interventricular Septal Thickness (IVST, mm), (E) Left Ventricular Posterior Wall Thickness in Diastole (LVPWd, mm) and (F) Right Ventricular (RV) mid-diameter (mm) at Baseline and Follow-up in Treatment (n = 19) Versus Comparison (n = 38). Data are presented as box plots showing the median and the range from minimum to maximum values. P-values were calculated using a mixed-effects model with repeated measures (REML). Significant differences were identified using Bonferroni correction for multiple comparisons, with p-values as follows: p < 0.001 (***), p < 0.01 (**), p < 0.05 (*), and p ≥ 0.05 (ns).

Figure 3. Changes in Derived Parameters of Cardiac Structure and Function in Patients with HFrEF and Obesity Undergoing Sleeve Gastrectomy (Treatment) Versus Standard of Care (Comparison). Comparison of (A) Fractional Shortening (FS, %), (B) Left Ventricular Mass Index (LVMI, g/m²), and (C) Relative Wall Thickness (RWT) at Baseline and Follow-up in Treatment (n = 19) Versus Comparison (n = 38). Data are presented as box plots showing the median and the range from minimum to maximum values. P-values were calculated using a mixed-effects model with repeated measures (REML). Significant differences were identified using Bonferroni correction for multiple comparisons, with p-values as follows: p < 0.001 (***), p < 0.01 (**), p < 0.05 (*), and p ≥ 0.05 (ns).

Figure 4. Changes in Medication Use in Patients with HFrEF and Obesity Undergoing Sleeve Gastrectomy (Treatment) Versus Standard of Care (Comparison). Comparison of (A) Total Medications (count), (B) Heart Failure (HF) Medications (count), and (C) Proportion of Patients Receiving Guideline-Directed Medical Therapy (GDMT) (Graded 0 to 4) at Baseline and Follow-up in Treatment (n = 20) Versus Comparison (n = 40). Data are presented as box plots showing the median and the range from minimum to maximum values, or as stacked bar charts showing the proportion of patients in each group. P-values were calculated using a mixed-effects model with repeated measures (REML). Significant differences were identified using Bonferroni correction for multiple comparisons, with p-values as follows: p < 0.001 (***), p < 0.01 (**), p < 0.05 (*), and p ≥ 0.05 (ns).

Figure 5. Kaplan-Meier Survival Curves Comparing Outcomes Between Patients with HFrEF and Obesity Undergoing Sleeve Gastrectomy (Treatment) Versus Standard of Care (Comparison). Kaplan-Meier curves depict (A) Overall survival, (B) Listing-free survival, (C) LVAD-free survival, and (D) Transplant-free survival in patients undergoing sleeve gastrectomy (Treatment, n=20) versus standard of care (Comparisonl, n=40). Shaded areas represent 95% confidence intervals. Survival rates were compared using the log-rank test, with p-values as follows: p < 0.001 (***), p < 0.01 (**), p < 0.05 (*) and p ≥ 0.05 (ns).