Bariatric Surgery in Patients With Left Ventricular Systolic Dysfunction

Impact of Obesity and Bariatric Surgery in the Outcome of Patients with Heart Failure

“…Recent studies, however, have suggested that, in obese individuals, concentric LVH and remodeling are as frequent as, or even more frequent than, eccentric LVH. 10,27 Mild LV systolic dysfunction can be present, but moderate to severe systolic dysfunction is rare and should trigger the search for comorbidities not directly related to obesity. 10,20 The presence of cardiac fibrosis in obese individuals is another important component of ventricular remodeling, increasing myocardial stiffness and diastolic dysfunction, resulting in clinical HF.…”

“…10,27 Mild LV systolic dysfunction can be present, but moderate to severe systolic dysfunction is rare and should trigger the search for comorbidities not directly related to obesity. 10,20 The presence of cardiac fibrosis in obese individuals is another important component of ventricular remodeling, increasing myocardial stiffness and diastolic dysfunction, resulting in clinical HF. Although it is important to recognize that such change can result from multiple conditions frequently associated with obesity, such as AH, dyslipidemia and DM, some studies have shown that fibrous remodeling of the ventricles resulting in significant diastolic dysfunction can occur in the absence of those comorbidities.…”

“…2 In Brazil, according to the BREATHE study, 3 coronary artery disease is the major cause of HF (30.3%), whose major causes of decompensation are poor medication adherence (30.0%), infections (23.0%) and inadequate control of water and sodium ingestion (9.0%). 3 Heart failure is currently known to be associated with obesity, 2,[4][5][6][7][8][9][10][11][12][13][14][15] regardless of the presence of comorbidities, such as arterial hypertension (AH) and coronary artery disease. 16,17 The Framingham Heart Study reports that to every 1-kg/m 2 increase in body mass index (BMI), the risk of developing HF increases by 5.0% in men and by 7.0% in women.…”

“…5 Furthermore, obesity has frequent associations, such as systemic AH, diabetes mellitus (DM), dyslipidemias and sleep obstructive apnea, increasing even more the likelihood of cardiac impairment. 19 Left ventricular hypertrophy (LVH) is the major cardiac morphological change related to obesity, 10,20 while diastolic dysfunction is the major functional change, manifested as elevated left ventricular (LV) end-diastolic pressure. 10 Obesity produces a variety of hemodynamic changes that can predispose to left and right ventricular dysfunction, even in the absence of cardiac comorbidities, a condition known as obesity cardiomyopathy.…”

“…19 Left ventricular hypertrophy (LVH) is the major cardiac morphological change related to obesity, 10,20 while diastolic dysfunction is the major functional change, manifested as elevated left ventricular (LV) end-diastolic pressure. 10 Obesity produces a variety of hemodynamic changes that can predispose to left and right ventricular dysfunction, even in the absence of cardiac comorbidities, a condition known as obesity cardiomyopathy. 20 Most obese patients with HF have preserved ejection fraction.…”