Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery

Abstract

Background Obesity is a systemic disorder associated with an increase in left ventricular mass and premature death and disability from cardiovascular disease. Although bariatric surgery reverses many of the hormonal and hemodynamic derangements, the long-term collective effects on body composition and left ventricular mass have not been considered before. Hypothesis The decline in fat mass and lean mass after weight loss surgery is associated with a decline in left ventricular mass. Methods Fifteen severely obese women (mean body mass index or BMI: 46.7 ± 1.7 kg/m2) with medically controlled hypertension underwent bariatric surgery. Left ventricular mass and plasma markers of systemic metabolism, together with BMI, waist and hip circumferences, body composition (fat mass and lean mass), and resting energy expenditure (REE) were measured at 0, 3, 9, 12 and 24 months. Results Left ventricular mass continued to decline linearly over the entire period of observation, while rates of weight-loss, loss of lean mass, loss of fat mass, and REE all plateaued at 9 months (p<0.001 for all). Parameters of systemic metabolism normalized by 9 months, and showed no further change at 24 months after surgery. Conclusions Even though parameters of obesity, including BMI and body composition, plateau, the benefits of bariatric surgery on systemic metabolism and left ventricular mass are sustained. We propose that the progressive decline of left ventricular mass after weight loss surgery is regulated by neurohumoral factors, and may contribute to improved long-term survival.

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

“…These factors are associated with the metabolic syndrome and have been implicated in the development of left ventricular hypertrophy and failure in the obese [12][13][14][15][16] . In a series of papers [9,10,17,18] we have been able to corroborate the positive effect of weight loss surgery on the metabolic profile, muscle metabolism, and cardiac structure and function. We demonstrated the reversal of lipid accumulation in muscle [9] and evidence of progressive cardiac remodeling for at least two years after surgery while patients remained clinically obese [10] .…”

“…In a series of papers [9,10,17,18] we have been able to corroborate the positive effect of weight loss surgery on the metabolic profile, muscle metabolism, and cardiac structure and function. We demonstrated the reversal of lipid accumulation in muscle [9] and evidence of progressive cardiac remodeling for at least two years after surgery while patients remained clinically obese [10] . Also, despite the apparent complications of weight loss surgery observed in Patient B, the lack of concomitant cardiac complications emphasizes the beneficial effects of weight loss surgery on the heart.…”

“…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.…”

“…She was part of a larger cohort of patients followed by us for two years after surgery [9,10] , and the only patient among the 42 patients to exhibit severe left ventricular systolic dysfunction. At surgery she weighed 128.1 kg with a BMI of 48.8 kg/m 2 and 53.2% fat mass (FM) (see Figure 1A, top panel).…”

How to Choose and Use Bariatric Surgery in 2015

“…161 Obesity is associated with increased LV mass. 162 Severe obesity causes an increase in total blood volume and cardiac output as a result of increased metabolic demand. 163 Ventricular chamber dilatation increases wall stress, which triggers increasing myocardial mass in an attempt to diminish wall stress.…”