Reversibility of Cardiovascular Changes in Extreme Obesity.

ABSTRACT. The effects of marked weight reduction on cardiovascular function in extreme obesity were studied before and on average 2 years after jejunoileostomy. In 17 female and 5 male patients, mean age 36 years, with obesity as the sole diagnosis, circulatory data were obtained at rest and during exercise through right heart catheterization. Blood volume and heart volume were measured and ECG was recorded at rest and during exercise. A mean weight loss of 58.1 kg reduced percentage overweight from 104 to 39%. Resting oxygen consumption and cardiac output fell in proportion to weight loss. A slightly hyperkinetic central circulation was observed during exercise. Stroke volume fell parallel to the decrease in blood volume and heart volume. Systemic arterial pressure declined, while systemic arterial resistance did not change. Left ventricular stroke work diminished. Although lower than preoperatively, the filling pressures of the right and left side of the heart were high in relation to cardiac output compared with healthy subjects. ECG at rest and during exercise remained normal. Thus, despite reductions in heart size and left ventricular stroke work, evidence of left ventricular dysfunction persisted. The observations indicate that the circulatory effects of gross obesity are largely reversible over weight loss periods of up to 3.5 years, apart from signs of a reduced myocardial wall compliance. The clinical implication seems to be that therapeutic weight‐reducing intervention should be made at a younger age.