Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery

Abstract

Objectives-There are several lines of evidence suggesting a link between obesity and heart failure, including chronic inflammation, increased sympathetic tone, and insulin resistance. The goal of this study was to evaluate the changes in systemic metabolism, anthropometrics, and left ventricular contraction as well as geometry in clinically severe obese women after bariatric surgery.Methods-Enrollment was offered consecutively to 22 women with clinically severe obesity. Participants had abdominal magnetic resonance imaging (MRI) to quantify visceral adipose tissue (VAT) area and tissue Doppler imaging (TDI) echocardiography to measure left ventricular (LV) contractile function. Fasting blood chemistries were drawn to measure inflammatory markers and to calculate insulin sensitivity. All tests were performed before surgery and three months postoperatively.Results-Three months after surgery there was a significant increase in insulin sensitivity [mean change (+/− SEM): 34.0(10.4), p<0.0001]. VAT significantly decreased [−66.1 cm 2 (17.8), p=0.002] and was associated with decreases in BMI, serum glucose concentrations, and hsCRP levels (r=0. 61, p=0.005, r=0.48, p=0.033, and r=0.53, p=0.016, respectively). Left ventricular mass significantly decreased [−3.8 g/m 2.7 (1.7), p=0.037] and this decrease was associated with a decrease in glucose concentrations (r=0.46, p=0.041). Left ventricular systolic and diastolic contractile function were normal at baseline and there was no change following surgery.Conclusions-The early phase of weight loss after bariatric surgery produces favorable changes in left ventricular geometry, and these are associated with normalization in glucose metabolism.

Two contrasting outcomes of weight loss surgery: Positive impact on the heart, negative impact on the liver

“…She returned to full time work within two months. While we have previously observed improved diastolic function, and a progressive decrease in LVM in obese patients following weight loss surgery [9][10][11] , in this patient there was a dramatic improvement in left ventricular systolic function as well.…”

Surgical Management of Obesity and the Relationship to Cardiovascular Disease

“…[126][127][128] As demonstrated in cohorts of 16 to 60 obese patients, there can be improvements in ventricular mass and diastolic function in the 3 months to 3.6 years after bariatric surgery in patients without baseline clinical cardiac disease. 110,[129][130][131][132] The most convincing improvements are seen in LV mass and mass index, E/A ratio, and isovolumic relaxation time. Importantly, the LV mass regression appears to be independent of postoperative systolic blood pressure changes.…”

Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study

“…Many also report the resolution of comorbidities such as hypertension and diabetes [6][7][8] and link remission of type 2 diabetes after LGBS to the amount of weight lost [6]. However, few studies of post-LGBS outcomes have measured visceral adipose tissue (VAT) loss in addition to weight loss [9,10]. VAT is thought to be a more potent contributor to development of hypertension, insulin resistance, and other obesity-related metabolic and cardiovascular abnormalities compared with subcutaneous adipose tissue [11,12] because of its greater metabolic activity and its access to the portal circulation [13,14].…”