Obesity is a major health problem worldwide and is associated with an increased risk of cardiovascular disease and mortality, including heart failure. Bariatric surgery has established itself as the most effective long-term treatment for weight loss. This procedure not only leads to significant weight loss, but also has a positive impact on cardiovascular risk factors such as blood pressure, blood sugar and cholesterol.
(red) The aim of the study discussed was to investigate the effects of bariatric surgery on left ventricular (LV) structure and function, particularly in relation to global longitudinal deformation (GLS), a sensitive measure of left ventricular function.
This retrospective study examined 398 patients who underwent bariatric surgery in a US healthcare system between 2004 and 2019. All patients had transthoracic echocardiograms before and after surgery, which allowed analysis of left ventricular structure and function. The main endpoint of the study was the change in LV GLS after surgery. Additional parameters, such as LV mass and left ventricular ejection fraction (LVEF), were also recorded.
After bariatric surgery, there was a significant improvement in cardiovascular risk factors, including a decrease in systolic blood pressure from 132 mmHg to 127 mmHg, a reduction in HbA1c from 6.5% to 5.7% and a decrease in LDL cholesterol from 97 mg/dL to 86 mg/dL. LV mass decreased significantly, from 205 g before surgery to 190 g after surgery. At the same time, LVEF increased from 58% to 60%, and LV-GLS improved from -15.7% to -18.6%.
The results of this study confirm that bariatric surgery not only contributes to weight loss, but also has significant positive effects on cardiac structure and function. The reduction in LV mass and improvement in LV GLS indicate a regression of left ventricular hypertrophy (LVH) and improved systolic function, potentially leading to a better prognosis for patients with obesity. These positive effects are consistent with previous studies that have shown similar improvements in LV function after bariatric surgery.
Cardiovascular benefits of bariatric surgery
Bariatric surgery not only reduces body weight, but also improves key cardiovascular risk factors, including hypertension, dyslipidemia and diabetes. These factors contribute significantly to the development of heart disease, particularly LVH and diastolic dysfunction. In this study, patients showed a significant reduction in systolic and diastolic blood pressure and an improvement in blood glucose levels after surgery. This suggests that improving metabolic health may also contribute to the reversibility of cardiac changes.
The reduction in LV mass after bariatric surgery is another important finding. Left ventricular hypertrophy is an established predictor of adverse cardiovascular events such as heart failure and sudden cardiac death. Studies show that the reduction of LV mass after bariatric surgery is associated with a better cardiovascular prognosis. A significant reduction in LV mass was also observed in this study, indicating a regression of hypertrophy.
Global longitudinal deformation (GLS) as an indicator of cardiac function
GLS has proven to be a sensitive marker for subclinical changes in cardiac function and is increasingly recognized as an important parameter in cardiology. Compared to LVEF, which often remains unchanged in patients with obesity, GLS can reveal changes in the early stages of cardiac dysfunction. This study showed a significant improvement in GLS values after bariatric surgery. This suggests that bariatric surgery not only reverses the structural changes in the heart, but also improves systolic function.
The improvement in GLS was significant in both male and female patients in this study. Males tended to have worse baseline LV GLS values and benefited from greater improvement postoperatively. The changes in LV GLS in the female patients were also significant and comparable to the male results, indicating that bariatric surgery has positive effects on cardiac function regardless of gender.
Long-term effects on heart health
The positive changes in left ventricular structure and function after bariatric surgery could reduce the risk of future cardiovascular events. The improvement in LVEF and GLS as well as the reduction in LV mass are important markers for a better prognosis in patients with obesity. In addition, the regression of LVH indicates a potential reduction in the risk of heart failure, which underlines the importance of bariatric surgery as a preventive measure to avoid cardiovascular complications.
Conclusion
The results of this study clearly show that bariatric surgery not only leads to weight loss, but also provides significant cardiovascular benefits. The reduction in LV mass, improvement in LV GLS and slight increase in LVEF suggest that bariatric surgery can play an important role in the treatment of patients with obesity and cardiovascular disease. Future prospective studies should focus on investigating the long-term cardiovascular benefits of bariatric surgery and defining the optimal patient population for this procedure.
Source:
- Hughes D, Aminian A, Tu C, et al: Impact of Bariatric Surgery on Left Ventricular Structure and Function. J Am Heart Assoc 2024 Jan 2;13(1): e031505. doi: 10.1161/JAHA.123.031505. Epub 2023 Dec 29. PMID: 38156532; PMCID: PMC10863834.
CARDIOVASC 2024; 23(3): 31-32
