Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function

Abstract

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

Cardiac and Metabolic Effects of Bariatric Surgery Among Obese Patients in a Malaysian Tertiary Hospital: A 6-month Prospective Cohort Study

“…29 An American Society of Echocardiography study in 2020 which looked at the impact of bariatric surgery on the echocardiographic features of cardiac remodeling and diastolic function concurred with our findings: patients with pre-existing diastolic dysfunction demonstrated improvements in diastolic function, driven by changes in TR velocity and medial E/e'. 30 The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics but also allows for early detection of subclinical left ventricular dysfunction. Multiple studies have shown a direct correlation between obesity and GLS pattern.…”

“… 29 An American Society of Echocardiography study in 2020 which looked at the impact of bariatric surgery on the echocardiographic features of cardiac remodeling and diastolic function concurred with our findings: patients with pre-existing diastolic dysfunction demonstrated improvements in diastolic function, driven by changes in TR velocity and medial E/e’. 30 …”