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

Figures

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  Figure 1. Changes in Cardiac Remodeling and Function Following Bariatric Surgery Graph bars represent the proportion of adults with preoperative (blue) and postoperative (gray). (A) Left ventricular hypertrophy, (B) abnormal diastolic function, and (C) abnormal systolic function (abnormal [left ventricular global longitudinal strain <18%]). ∗P < 0.05, ∗∗ <0.01, ∗∗∗<0.001. LV = left ventricular.

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  Figure 2. Changes in Patterns of Left Ventricular Remodeling After Bariatric Surgery Left ventricular remodeling was classified into 1 of 4 categories based on left ventricular mass index (left ventricular mass/height 2.7) and relative wall thickness. The numbers inside the bar are the actual corresponding percentage of individuals within each pattern. At baseline, eccentric hypertrophy was the most common pattern. After 12 months of follow-up, there was a shift toward less eccentric hypertrophy and more concentric remodeling.

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  Figure 3. Visceral Adiposity and Diastolic Function Following Bariatric Surgery Visceral fat levels (n = 21) (A), left atrial dimension (B), lateral E/e’ ratio (C), and E/A ratio (D), in the preoperative period and at 12 months after bariatric surgery. The boxes are presented with median (central line), percentiles 25 (lower line) and 75 (upper line). Whiskers represent the upper and lower adjacent values. ∗ <0.05, ∗∗ <0.01, ∗∗∗< 0.001 compared with the presurgery. LA = left atrial.

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  Figure 4. Global Adiposity, Cardiac Remodeling, and Function Following Bariatric Surgery Body mass index (A), left ventricular mass (B) and left ventricular global longitudinal strain (C) in the preoperative period (presurgery), at 12 months after bariatric surgery (postsurgery) vs obese controls (no surgery). The boxes are presented with median (central line), percentiles 25 (lower line) and 75 (upper line). Whiskers represent the upper and lower adjacent values. ∗ <0.05, ∗∗ <0.01, ∗∗∗<0.001 compared with the preoperative surgical group. § < 0.05, §§ < 0.01, §§§ <0.001 compared with the postoperative surgical group. LV = left ventricular; BMI = body m index.

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  Central Illustration. Benefits of Bariatric Surgery on Cardiac Remodeling and Function in Prevention of Heart Failure This figure shows that surgical treatment of obesity (biliopancreatic diversion with duodenal switch) exerts important cardioprotective effects in adults with severe obesity through reduction in visceral adiposity, and a favorable effect on metabolic conditions, heart rate variability parameters, cardiac remodeling (left ventricular hypertrophy regression, reduction of left atrial dimension), diastolic function, and improvement in biventricular systolic function (left and right ventricular strain). These results demonstrate the high potential of surgical treatment of obesity as a valuable strategy for heart failure prevention and regression. CV = cardiovascular; HFpEF = heart failure with preserved ejection fraction.