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The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes

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Abstract

Background

Obesity is associated with cardiac dysfunction, atherosclerosis, and increased cardiovascular risk. It can be lead to obesity cardiomyopathy and severe heart failure, which in turn raise morbidity and mortality while carrying a negative impact on quality of life. There is increasing clinical and mechanistic evidence on the metabolic and weight loss effects of bariatric surgery on improving cardiac structure and function in obese patients.

Objectives

The objective of this study was to quantify the effects of bariatric surgery on cardiac structure and function by appraising cardiac imaging changes before and after metabolic operations.

Methods

This is a comprehensive systematic review of studies reporting pre-operative and post-operative echocardiographic or magnetic resonance cardiac indices in obese patients undergoing bariatric surgery. Studies were quality scored, and data were meta-analyzed using random effects modeling.

Results

Bariatric surgery is associated with significant improvements in the weighted incidence of a number of cardiac indices including a decrease in left ventricular mass index (11.2 %, 95 % confidence intervals (CI) 8.2–14.1 %), left ventricular end-diastolic volume (13.28 ml, 95 % CI 5.22–21.34 ml), and left atrium diameter (1.967 mm, 95 % CI 0.980–2.954). There were beneficial increases in left ventricular ejection fraction (1.198 %, 95 %CI −0.050–2.347) and E/A ratio (0.189 %, 95 %CI −0.113–0.265).

Conclusions

Bariatric surgery offers beneficial cardiac effects on diastolic function, systolic function, and myocardial structure in obese patients. These may derive from surgical modulation of an enterocardiac axis. Future studies must focus on higher evidence levels to better identify the most successful bariatric approaches in preventing and treating the broad spectrum of obesity-associated heart disease while also enhancing treatment strategies in the management of obesity cardiomyopathy.

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Abbreviations

LVMI:

Left ventricular mass index

LVESV:

Left ventricular end-systolic volume

LVESD:

Left ventricular end-systolic diameter

LVEDV:

Left ventricular end-diastolic volume

LVEDD:

Left ventricular end-diastolic diameter

LVEF:

Left ventricular ejection fraction

PWT:

Posterior wall thickness

IVST:

Interventricular septal thickness

RWT:

Relative wall thickness

IVRT:

Isovolumic relaxation time

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Acknowledgments

We would like to acknowledge Dr. Oliver Rider of the Division of Cardiovascular Medicine, The Radcliffe Department of Medicine (RDM), University of Oxford, who kindly shared original data from his study.

Conflict of Interest

The authors declare that they have no conflict of interests.

Ethical Approval

For this type of study, formal consent is not required.

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Authors and Affiliations

  1. The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College Healthcare NHS Trust at St Mary’s Hospital, Praed Street, London, W2 1NY, UK

    Ravi Aggarwal, Leanne Harling, Evangelos Efthimiou, Ara Darzi, Thanos Athanasiou & Hutan Ashrafian

  2. Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK

    Leanne Harling & Thanos Athanasiou

  3. Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, UK

    Evangelos Efthimiou & Hutan Ashrafian

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  1. Ravi Aggarwal
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  2. Leanne Harling
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  3. Evangelos Efthimiou
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  4. Ara Darzi
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  5. Thanos Athanasiou
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  6. Hutan Ashrafian
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Correspondence to Hutan Ashrafian.

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Aggarwal, R., Harling, L., Efthimiou, E. et al. The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes. OBES SURG 26, 1030–1040 (2016). https://doi.org/10.1007/s11695-015-1866-5

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