Cardiac remodeling after bariatric surgery associates with systemic metabolic reprogramming: a longitudinal untargeted metabolomics study

Abstract Background Obesity is a major contributor to adverse cardiac remodeling, particularly concentric left ventricular remodeling (LVCR), which is associated with diastolic dysfunction and increased cardiovascular risk. Bariatric surgery reverses many obesity-related comorbidities, including structural myocardial alterations. However, the molecular underpinnings of cardiac recovery, particularly metabolomic correlates, remain poorly understood. Objective This study aimed to characterize longitudinal changes in the serum metabolome of patients undergoing bariatric surgery and to investigate the relationship between these metabolic shifts and the regression of concentric cardiac remodeling. Methods A cohort of 127 adults with severe obesity was evaluated at baseline and 4, 12, and 24 weeks post-surgery. Echocardiographic parameters were assessed to define cardiac remodeling. Untargeted GC–MS-based metabolomic profiling was performed on serum samples. Multivariate models (PLS-DA), LASSO regression, and pathway enrichment analyses were employed to identify discriminant metabolites and predictors of remodeling outcomes. Results Changes in cardiac geometry primarily occurred within the first 12 weeks after the intervention and were mainly driven by reductions in relative wall thickness (RWT). Left ventricular mass index (LVMI) showed only modest, non-significant changes at the cohort level, consistent with the predominantly non-hypertrophic baseline profile. Metabolomic profiling showed time-dependent shifts involving amino acid, fatty acid, and ketone metabolism. Patients who experienced early favorable cardiac remodeling after bariatric surgery demonstrated enriched signatures of mitochondrial substrate flexibility, including short-chain fatty acids, branched-chain amino acid metabolites, and dicarboxylic acids. LASSO regression identified specific sets of metabolites associated with reductions in LVMI and RWT. Conclusion Early geometric cardiac adaptation following bariatric surgery—primarily reflected by reductions in relative wall thickness (RWT), with modest and non-significant changes in LVMI at the cohort level—is associated with coordinated changes in systemic metabolic profiles. These findings suggest potential metabolic correlates of early cardiac adaptation while highlighting substantial interindividual variability. Metabolomic profiling provides insights into individual metabolic trajectories and may inform future strategies for cardiometabolic risk stratification.