Key result
Bariatric surgery significantly improved left ventricular ejection fraction (from 59% to 67%, P<0.001) and right ventricular ejection fraction (from 60% to 68%, P=0.0001) at 6 months.
Why the study?
Does bariatric surgery improve ventricular remodelling in obese patients free of cardiac disease?
Cohort (n=52)
No
Does bariatric surgery improve ventricular remodelling in obese patients free of cardiac disease?
Absolute Event Rate: 67% vs 59%
p-value: p=<0.001
Bariatric surgery induces significant left and right ventricular reverse remodelling and improves longitudinal strain at 6 months in obese patients without known cardiac disease.
Bariatric surgery was associated with reverse LV/RV remodelling; leaves open whether sleeve gastrectomy and bypass differ in low-risk patients.
AIMS: The aim of the study was to examine ventricular remodelling in patients free of cardiac risk factors, before, and 6 months post-bariatric surgery with the new imaging modality of three-dimensional (3D) strain and the comparison of two surgical techniques: sleeve gastrectomy vs. gastric bypass. METHODS AND RESULTS: Fifty-two consecutive patients referred to the Bariatric Services of Imperial College NHS Trust were examined with conventional 2D and 3D strain echocardiography, prior to and 6 months after bariatric surgery. They were all free from cardiac disease. The study cohort's mean age was 44.2 ± 8.7 years and body mass index of 42.4 ± 4.6 g/m(2) prior to surgery. Eighteen patients (34.6%) underwent laparoscopic sleeve gastrectomy, and 34 laparoscopic gastric bypass. On 3D speckle tracking, there was significant reverse remodelling post-bariatric surgery [left ventricular (LV) ejection fraction (EF): pre-surgery: 59 ± 8% vs. post-surgery: 67 ± 7%, P < 0.001 and right ventricular (RV) EF: pre-surgery: 60 ± 9% vs. post-surgery: 68 ± 8.2%, P = 0.0001]. Furthermore, there was significant regression of mass (LV mass: pre-surgery: 111 ± 23.5 g vs. post-surgery: 92.8 ± 15.5 g and RV mass: pre-surgery: 95.2 ± 19.8 vs. post-surgery: 67.3 ± 16.3, P < 0.001). RV and LV global strain improved 6 months post-bariatric surgery: global RV strain: pre-surgery -11.7 ± 4 vs. post-surgery -17.52 ± 3.7, P < 0.001; global LV strain: pre-surgery: -20.2 ± 1.7 vs. post-surgery: -26.5 ± 1.86, P < 0.001. Sleeve gastrectomy and gastric bypass had comparable effects. CONCLUSION: Bariatric surgery has an important effect in reverse LV and RV remodelling and it substantially improves RV longitudinal strain.
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Kaier et al. (2014) conducted a cohort in Obesity (n=52). Bariatric surgery vs. Pre-surgery baseline was evaluated on Left ventricular ejection fraction (p=<0.001). Bariatric surgery significantly improved left ventricular ejection fraction (from 59% to 67%, P<0.001) and right ventricular ejection fraction (from 60% to 68%, P=0.0001) at 6 months.
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