One-year impact of bariatric surgery on left ventricular mechanics: results from the prospective FatWest study

Abstract

Aims Patients with severe obesity are predisposed to left ventricular (LV) hypertrophy, increased myocardial oxygen demand, and impaired myocardial mechanics. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. The present prospective study assesses whether LV wall mechanics improve 1 year after bariatric surgery. Methods and results Ninety-four severely obese patients [43 ± 10 years, 71% women, body mass index (BMI) 41.8 ± 4.9 kg/m2, 57% with hypertension] underwent echocardiography before, 6 months and 1 year after gastric bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), LV power/mass as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, and myocardial oxygen demand as the LV mass-wall stress-heart rate product. Surgery induced a significant reduction in BMI, heart rate, and BP (P < 0.001). Prevalence of LV hypertrophy fell from 35% to 19% 1 year after surgery (P < 0.001). The absolute value of GLS improved by—4.6% (i.e. 29% increase in GLS) while LV ejection fraction, MWS, and LV power/mass remained unchanged. In multivariate regression analyses, 1 year improvement in GLS was predicted by lower preoperative GLS, larger mean BP, and BMI reduction (all P < 0.05). Low 1-year MWS was associated with female sex, preoperative hypertension, and higher 1-year LV relative wall thickness and myocardial oxygen demand (all P < 0.001). Conclusion In severely obese patients, LV longitudinal function is largely recovered one year after bariatric surgery due to reduced afterload. LV midwall mechanics does not improve, particularly in women and patients with persistent LV geometric abnormalities. ClinicalTrials.gov identifier NCT01533142, 15 February 2012.

Bariatric Surgery and Myocardial Mechanics: A Meta-Analysis of Speckle Tracking Echocardiographic Studies

“…Our meta-analysis documented that the LVEF did not change significantly after bariatric surgery. Some studies did not report any LVEF improvement [ 16 , 19 , 20 , 22 , 26 ]; this was not the case with GLS, which was significantly improved in all examined studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The present meta-analysis also demonstrated that only GLS, but not LVEF, was improved regardless of the duration of the follow-up.…”

“…Therefore, 102 studies were reviewed; of these, 77 did not report data on myocardial mechanics, and 24 were reviews, commentary, editorial articles, case reports and studies including less than 10 participants. Thus, a total of 13 studies including patients treated with bariatric surgery for a period longer than one month and containing echocardiographic data of interest were included in the final review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] ( Figure 1 ). According to the NOS, the quality of the studies ranged from 6 to 9 (i.e., a score that identifies studies of fair or good quality) [ 29 ].…”

“…The parameters more frequently associated with GLS improvement were reduction in BMI and BP [ 16 , 22 , 26 ]. Our meta-analysis failed to demonstrate a relationship between BMI reduction and GLS improvement after bariatric surgery.…”

“…Our meta-analysis failed to demonstrate a relationship between BMI reduction and GLS improvement after bariatric surgery. Grymyr et al suggested that change in LV geometry, particularly a reduction in eccentric LVH prevalence, one year after bariatric surgery may contribute to GLS improvement [ 26 ]. The influence of gender on GLS increase should be taken into account, as GLS improved more significantly in men than in women (6.7% vs. 3.9%, p < 0.05) [ 26 ].…”

Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications

“…19 LV hypertrophy was identified as recommended in populations with higher prevalence of obesity as LV mass indexed for height 2.7 ≥49.2 g/m 2.7 in men and ≥46.7 g/m 2.7 in women. [20][21][22] The ratio of LV end-diastolic posterior wall thickness/internal diameter (the relative wall thickness) indicated concentric LV geometry when ≥0.43. 23 LV systolic function was assessed by both EF and global left ventricular longitudinal strain (GLS; low if less negative than −16.7% in men and <−17.8% in women) using all 3 standard apical views.…”