Effects of glucagon-like peptide 1 receptor agonists versus bariatric surgeries on cardiac function improvement: a network meta-analysis

Introduction Weight loss has been shown to reverse adverse cardiac remodeling and reduce major adverse cardiovascular events. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapy for patients with obesity and have demonstrated potential benefits in improving cardiac function. Purpose This network meta-analysis aims to compare the effects of weight management strategies: (1) bariatric surgery, (2) GLP-1 RAs compared with standard care on the improvement of echocardiographic and cardiac magnetic resonance imaging findings. Methods We searched PubMed, Scopus, and the Cochrane Library databases for studies with head-to-head comparison of each weight management strategy in patients with obesity up until February 2026. Bariatric procedures included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion with duodenal switch (BPD-DS). GLP-1 RAs included liraglutide, exenatide, semaglutide, albiglutide, and tirzepatide. The primary outcomes were early diastolic transmitral inflow velocity (E), diastolic mitral annular tissue velocity (e’), left ventricular (LV) ejection fraction (LVEF), and LV mass index (LVMI). Secondary outcomes were LV volume and diameter, left atrial (LA) volume and diameter, global longitudinal strain (GLS), cardiac wall thickness, and epicardial adipose tissue (EAT) at 1-year follow-up. Results A total of 54 studies comprising 5,857 patients were included in this analysis (24 bariatric surgery; 31 GLP-1 RA; 54 standard care/placebo/sham procedure). At 1-year follow-up, bariatric surgery was associated with significant improvements in cardiac remodeling compared with control. SG significantly increased LVEF (MD 16.50%; 95% CI 10.41–22.59) and reduced LV end-diastolic diameter (MD −5.20 mm; 95% CI −8.67 to −1.73). RYGB significantly reduced LV mass (MD −29.81 g; 95% CI −44.83 to −14.79) and LA diameter (MD −3.24 mm; 95% CI −5.06 to −1.43). Among GLP-1 receptor agonists, exenatide significantly improved diastolic function and myocardial deformation, including an increase in E’ velocity, a reduction in E/e’ ratio (MD −2.64; 95% CI −4.48 to −0.81), and improved global longitudinal strain (MD −2.10%; 95% CI −2.90 to −1.30). Liraglutide significantly reduced left ventricular mass and epicardial adipose tissue thickness (MD −0.70 mm; 95% CI −1.32 to −0.08), while exenatide demonstrated a marked reduction in epicardial adipose tissue (MD −7.60 mm; 95% CI −8.70 to −6.50). Conclusion Bariatric surgery improves structural cardiac remodeling, while GLP-1 receptor agonists mainly enhance myocardial function and reduce cardiac adiposity. Weight management is an important strategy for improving cardiac function in patients with obesity.