Should We Target Obesity in Advanced Heart Failure?

Heart Failure (W Tang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Heart Failure

Opinion statement

Obesity is a risk factor for the development of heart failure (HF), but has been associated with improved survival in patients with established HF. Weight loss should clearly be recommended and supported for obese individuals without cardiac pathology to prevent cardiomyopathy development. Clinical recommendations at the other end of the obesity heart failure spectrum are also relatively clear. Morbidly obese individuals (BMI ≥ 40 kg/m2) aged <50 years with severely depressed systolic function and NYHA class III-IV symptoms should be considered for malabsorptive bariatric surgery at an experienced center. The goal is either improved systolic function and symptoms, or sufficient weight loss for heart transplant eligibility. Recommendations for patients falling between these extremes are more challenging. Overweight and mildly obese HF patients (25–35 kg/m2) may be somewhat protected from cardiac cachexia and weight loss is not expected to enhance survival, but may offer symptomatic benefits.


Obesity Heart failure Left ventricular dysfunction Echocardiography Adipokines Bariatric surgery Obesity paradox 


Compliance with Ethics Guidelines

Conflict of Interest

Dr. Amanda R Vest received travel/accommodations expenses covered or reimbursed by the American Heart Association and is employed by the Cleveland Clinic. Dr. James B Young declares that he has no conflicts of interest. The authors did not receive funding for this work, and they have no financial relationships or other industry disclosures to make.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875–80.PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization. World Health Statistics, 2011. WHO. 2011;1–171.Google Scholar
  3. 3.
    Poirier P. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 AHA Scientific Statement on Obesity and Heart Disease. Circulation. 2006;113(6):898–918.PubMedCrossRefGoogle Scholar
  4. 4.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235.PubMedCrossRefGoogle Scholar
  5. 5.
    Djoussé L, Bartz TM, Ix JH, Zieman SJ, Delaney JA, Mukamal KJ, et al. Adiposity and incident heart failure in older adults: the Cardiovascular Health Study. Obesity. 2011;20(9):1936–41.Google Scholar
  6. 6.
    Kenchaiah S, Sesso HD, Gaziano JM. Body mass index and vigorous physical activity and the risk of heart failure among men. Circulation. 2009;119(1):44–52.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.•
    Loehr LR, Rosamond WD, Poole C, McNeill AM, Chang PP, Folsom AR, et al. Association of multiple anthropometrics of overweight and obesity with incident heart failure. Circ Heart Fail. 2009;2(1):18–24. A 14,641-patient longitudinal cohort analysis demonstrating the association between generalized obesity and central adiposity over 16 years' median follow-up. This study demonstrates that the anthropomorphic metrics of BMI, waist circumference, and waist-hip ratio are essentially equivalent in their prediction of HF risk and that the elevated HF risk persists after adjustment for key confounders such as age, smoking, and educational level.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.••
    Hu G, Jousilahti P, Antikainen R, Katzmarzyk PT, Tuomilehto J. Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure. Circulation. 2010;121(2):237–44. Builds on the observations of Loehr et al. with a large cohort of 59,178 Finnish participants followed for HF incidence over a mean of 18.4 years. General and central adiposity was independently associated with HF risk, whereas moderate or high levels of physical activity reduced the risk of HF development. This paper showed a protective effect of physical activity at all levels of BMI, which highlights the value of a comprehensive lifestyle intervention for HF prevention.PubMedCrossRefGoogle Scholar
  9. 9.
    Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Obesity and risk of incident heart failure in older men with and without pre-existing coronary heart disease: does leptin have a role? J Am Coll Cardiol. 2011;58(18):1870–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321(4):225–36.PubMedCrossRefGoogle Scholar
  11. 11.
    Li X, Li S, Ulusoy E, Chen W, Srinivasan SR, Berenson GS. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study. Circulation. 2004;110(22):3488–92.PubMedCrossRefGoogle Scholar
  12. 12.
    van Putte-Katier N, Rooman RP, Haas L, Verhulst SL, Desager KN, Ramet J, et al. Early cardiac abnormalities in obese children: importance of obesity per se vs. associated cardiovascular risk factors. Pediatr Res. 2008;64(2):205–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Mehta S, Holliday C, Hayduk L, Wiersma L, Ricahrds N, Younoszai A. Comparison of myocardial function in children with body mass indexes ≥25 vs. those <25 kg/m2. Am J Cardiol. 2004;93(12):1567–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, et al. Impact of obesity on cardiac geometry and function in a population of adolescents. J Am Coll Cardiol. 2006;47(11):2267–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Saltijeral A, de Isla LP, Pérez-Rodríguez O, Rueda S, Fernandez-Golfin C, Almeria C, et al. Early myocardial deformation changes associated to isolated obesity: a study based on 3D-wall motion tracking analysis. Obesity. 2011;19(11):2268–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51(14):1342–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Michalsky MP, Raman SV, Teich S, Schuster DP, Bauer JA. Cardiovascular recovery following bariatric surgery in extremely obese adolescents: preliminary results using Cardiac Magnetic Resonance (CMR) Imaging. J Pediatr Surg. 2013;48(1):170–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Hu S-J, Liu S-X, Katus HA, Luedde M. The value of contrast dobutamine stress echocardiography in detecting coronary artery disease in overweight and obese patients. Can J Cardiol. 2007;23(11):885–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Clerico A, Giannoni A, Vittorini S, Emdin M. The paradox of low BNP levels in obesity. Heart Fail Rev. 2012;17(1):81–96.PubMedCrossRefGoogle Scholar
  20. 20.
    Ingelsson E, Ärnlöv J, Lind L, Sundström J. Metabolic syndrome and risk for heart failure in middle-aged men. Heart. 2006;92(10):1409–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Wang J, Sarnola K, Ruotsalainen S, Moilanen L, Lepistö P, Laakso M, et al. The metabolic syndrome predicts incident congestive heart failure: a 20-year follow-up study of elderly Finns. Atherosclerosis. 2010;210(1):237–42.PubMedCrossRefGoogle Scholar
  22. 22.••
    Voulgari C, Tentolouris N, Dilaveris P, Tousoulis D, Katsilambros N, Stefanadis C. Increased heart failure risk in normal-weight people with metabolic syndrome compared with metabolically healthy obese individuals. J Am Coll Cardiol. 2011;58(13):1343–50. Five hundred and fifty nondiabetic patients enrolled in a prospective, community-based study were studied for HF development over 6 years. Subjects with metabolic syndrome who were normal weight, overweight, or obese with had approximately 2.3, 2.6, and 2.1 times higher adjusted odds of developing HF, respectively, compared with subjects without metabolic syndrome. The strength of the relationship between metabolic syndrome and HF incidence persisted after adjustment for age, sex, current smoking, physical inactivity, lipids, glycemic, and inflammation profile. In contradiction to many of the above studies, obesity status and BMI were not independent predictors of 6-year HF risk in this cohort. This could be because of the relatively small cohort size, or perhaps because obesity is actually a surrogate for metabolic dysfunction in studies such as Loehr et al. and Hu et al., rather than a true etiological factor.PubMedCrossRefGoogle Scholar
  23. 23.
    McManus DD, Lyass A, Ingelsson E, Massaro JM, Meigs JB, Aragam J, et al. Relations of circulating resistin and adiponectin and cardiac structure and function: the Framingham Offspring Study. Obesity. 2012;20(9):1882–6.Google Scholar
  24. 24.
    Bays HE, Abate N, Chandalia M. Adiposopathy: sick fat causes high blood sugar, high blood pressure and dyslipidemia. Future Cardiol. 2005;1(1):39–59.PubMedCrossRefGoogle Scholar
  25. 25.
    Bays HE. Adiposopathy. J Am Coll Cardiol. 2011;57(25):2461–73.PubMedCrossRefGoogle Scholar
  26. 26.
    Ukkola O, Santaniemi M. Adiponectin: a link between excess adiposity and associated comorbidities? J Mol Med. 2002;80(11):696–702.PubMedCrossRefGoogle Scholar
  27. 27.
    Skurk C, Wittchen F, Suckau L, Witt H, Noutsias M, Fechner H, et al. Description of a local cardiac adiponectin system and its deregulation in dilated cardiomyopathy. Eur Heart J. 2008;29(9):1168–80.PubMedCrossRefGoogle Scholar
  28. 28.
    George J, Patal S, Wexler D, Sharabi Y, Peleg E, Kamari Y, et al. Circulating adiponectin concentrations in patients with congestive heart failure. Heart. 2006;92(10):1420–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Nakamura T, Funayama H, Kubo N, Yasu T, Kawakami M, Saito M, et al. Association of hyperadiponectinemia with severity of ventricular dysfunction in congestive heart failure. Circ J. 2006;70(12):1557–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Schulze PC, Biolo A, Gopal D, Shahzad K, Balog J, Fish M, et al. Dynamics in insulin resistance and plasma levels of adipokines in patients with acute decompensated and chronic stable heart failure. J Card Fail. 2011;17(12):1004–11.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Khan RS, Kato TS, Chokshi A, Chew M, Yu S, Wu C, et al. Adipose tissue inflammation and adiponectin resistance in patients with advanced heart failure: correction after ventricular assist device implantation. Circ Heart Fail. 2012;5:340–8.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Butler J, Kalogeropoulos A, Georgiopoulou V, de Rekeneire N, Rodondi N, Smith AL, et al. Serum resistin concentrations and risk of new onset heart failure in older persons. Arterioscler Thromb Vasc. 2009;29(7):1144–9.CrossRefGoogle Scholar
  33. 33.
    Frankel DS, Vasan RS, D’Agostino RB, Benjamin EJ, Levy D, Wang TJ, et al. Resistin, adiponectin, and risk of heart failure the Framingham offspring study. J Am Coll Cardiol. 2009;53(9):754–62.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Takeishi Y, Niizeki T, Arimoto T, Nozaki N, Hirono O, Nitobe J, et al. Serum resistin is associated with high risk in patients with congestive heart failure—a novel link between metabolic signals and heart failure. Circ J. 2007;71(4):460.PubMedCrossRefGoogle Scholar
  35. 35.
    Kim M, Oh JK, Sakata S, Liang I, Park W, Hajjar RJ, et al. Role of resistin in cardiac contractility and hypertrophy. J Mol Cell Cardiol. 2008;45(2):270–80.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Tretjakovs P, Jurka A, Bormane I, Mackevics V, Mikelsone I, Balode L, et al. Relation of inflammatory chemokines to insulin resistance and hypoadiponectinemia in coronary artery disease patients. Eur J Intern Med. 2009;20(7):712–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Schulze PC, Kratzsch J, Linke A, Schoene N, Adams V, Gielen S, et al. Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure. Eur J Heart Fail. 2003;5(1):33–40.PubMedCrossRefGoogle Scholar
  38. 38.
    McGaffin KR, Moravec CS, McTiernan CF. Leptin signaling in the failing and mechanically unloaded human heart. Circ Heart Fail. 2009;2(6):676–83.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Purdham DM, Zou M-X, Rajapurohitam V, Karmazyn M. Rat heart is a site of leptin production and action. Am J Physiol Heart Circ Physiol. 2004;287(6):H2877–84.PubMedCrossRefGoogle Scholar
  40. 40.
    Madani S, De Girolamo S, Muñoz DM, Li RK, Sweeney G. Direct effects of leptin on size and extracellular matrix components of human pediatric ventricular myocytes. Cardiovasc Res. 2006;69(3):716–25.PubMedCrossRefGoogle Scholar
  41. 41.
    Kalupahana NS, Massiera F, Quignard-Boulange A, Ailhaud G, Voy BH, Wasserman DH, et al. Overproduction of angiotensinogen from adipose tissue induces adipose inflammation, glucose intolerance, and insulin resistance. Obesity. 2012;20(1):48–56.PubMedCrossRefGoogle Scholar
  42. 42.
    Bahrami H, Bluemke D, Kronmal R, Bertoni AG, Lloyd-Jones DM, Shahar E, et al. Novel metabolic risk factors for incident heart failure and their relationship with obesity. J Am Coll Cardiol. 2008;51(18):1775–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Lavie CJ, Osman AF, Milani RV, Mehra MR. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol. 2003;91(7):891–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.PubMedCrossRefGoogle Scholar
  45. 45.
    Nagaya N, Uematsu M, Kojima M, Ikeda Y, Yoshihara F, Shimizu W, et al. Chronic administration of ghrelin improves left ventricular dysfunction and attenuates development of cardiac cachexia in rats with heart failure. Circulation. 2001;104(12):1430–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Nagaya N, Miyatake K, Uematsu M, Oya H, Shimizu W, Hosoda H, et al. Hemodynamic, renal, and hormonal effects of ghrelin infusion in patients with chronic heart failure. J Clin Endocrinol Metab. 2001;86(12):5854–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Nagaya N, Moriya J, Yasumura Y, Uematsu M, Ono F, Shimizu W, et al. Effects of ghrelin administration on left ventricular function, exercise capacity, and muscle wasting in patients with chronic heart failure. Circulation. 2004;110(24):3674–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Vila G, Grimm G, Resl M, Heinisch B, Einwallner E, Esterbauer H, et al. B-type natriuretic Peptide modulates ghrelin, hunger, and satiety in healthy men. Diabetes. 2012;61(10):2592–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Polak J, Kotrc M, Wedellova Z, Jabor A, Malek I, Kautzner J, et al. Lipolytic effects of B-type natriuretic peptide 1–32 in adipose tissue of heart failure patients compared with healthy controls. J Am Coll Cardiol. 2011;58(11):1119–25.PubMedCrossRefGoogle Scholar
  50. 50.
    Nikolaidis LA, Mankad S, Sokos GG, Miske G, Shah A, Elahi D, et al. Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion. Circulation. 2004;109(8):962–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Sokos GG, Nikolaidis LA, Mankad S, Elahi D, Shannon RP. Glucagon-like peptide-1 infusion improves left ventricular ejection fraction and functional status in patients with chronic heart failure. J Card Fail. 2006;12(9):694–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Woo MA, Tillisch JH. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol. 2001;38(3):789–95.PubMedCrossRefGoogle Scholar
  53. 53.••
    Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156(1):13–22. A meta-analysis of 28,209 patients across 9 studies, mainly ad hoc analyses of HF therapy trials, which supports the obesity survival paradox. Compared with patients with normal BMI, obesity and overweight were both associated with a lower risk of adjusted all-cause mortality (adjusted HR 0.88, 95% CI 0.83–0.93 and adjusted HR 0.93, 95% CI 0.89–0.97, respectively), which was a consistent finding across the component studies. Conversely, underweight/low-normal-weight patients had a higher risk-adjusted mortality (adjusted HR 1.11, 95% CI 1.01–1.23). This provides some of the strongest evidence that well-managed HF patients derive some mortality benefit from their adiposity.PubMedCrossRefGoogle Scholar
  54. 54.
    Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. Am Heart J. 2010;159(1):75–80.PubMedCrossRefGoogle Scholar
  55. 55.
    Futter JE, Cleland JGF, Clark AL. Body mass indices and outcome in patients with chronic heart failure. Eur J Heart Fail. 2011;13(2):207–13.PubMedCrossRefGoogle Scholar
  56. 56.
    Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165(1):55–61.PubMedCrossRefGoogle Scholar
  57. 57.
    Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J. 2007;153(1):74–81.PubMedCrossRefGoogle Scholar
  58. 58.
    Clark AL, Fonarow GC, Horwich TB. Waist circumference, body mass index, and survival in systolic heart failure: the obesity paradox revisited. J Card Fail. 2011;17(5):374–80.PubMedCrossRefGoogle Scholar
  59. 59.
    Horwich TB, Broderick S, Chen L, McCullough PA, Strzelczyk T, Kitzman DW, et al. Relation among body mass index, exercise training, and outcomes in chronic systolic heart failure. Am J Cardiol. 2011;108(12):1754–9.PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved vs. reduced ejection fraction. J Am Coll Cardiol. 2012;59(11):998–1005.PubMedCrossRefGoogle Scholar
  61. 61.
    Abdulla J, Kober L, Abildstrøm SZ, Christensen E, James WPT, Torp-Pedersen C. Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries. 2008;29(5):594–601.Google Scholar
  62. 62.
    Zamora E, Lupón J, de Antonio M, Urrutia A, Coll R, Díez C, et al. The obesity paradox in heart failure: is etiology a key factor? Int J Cardiol. 2013;166(3):601–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Kenchaiah S, Pocock SJ, Wang D, Finn PV, Zornoff LAM, Skali H, et al. Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program. Circulation. 2007;116(6):627–36.PubMedCrossRefGoogle Scholar
  64. 64.
    Aziz EF, Javed F, Pratap B, Musat D, Nader A, Pulimi S, et al. Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis. Heart Int. 2011;6(1):e2.PubMedCentralPubMedGoogle Scholar
  65. 65.
    Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, et al. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet. 2003;361(9363):1077–83.PubMedCrossRefGoogle Scholar
  66. 66.
    Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2011;10, CD008066.PubMedGoogle Scholar
  67. 67.
    Bays HE. Lorcaserin and adiposopathy: 5-HT2c agonism as a treatment for “sick fat” and metabolic disease. Expert Rev Cardiovasc Ther. 2009;7(11):1429–45.PubMedCrossRefGoogle Scholar
  68. 68.
    Rucker D, Padwal R, Li S, Curioni C, Lau DCW. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335(7631):1194–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Leichman JG, Aguilar D, King TM, Mehta S, Majka C, Scarborough T, et al. Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery. Surg Obes Relat Dis. 2006;2(6):592–9.PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  71. 71.•
    Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. A key cardiovascular paper in the bariatric surgery field, demonstrating the potential for surgical weight loss to achieve long-term reductions in cardiovascular events and mortality. This publication reported on 2,010 obese participants who underwent bariatric surgery in the Swedish Obese Subjects (SOS) trial and 2,037 contemporaneously matched obese controls who received usual care. Bariatric surgery was associated with a reduced number of cardiovascular deaths (adjusted HR 0.47, 95% CI 0.29–0.76, P = 0.002) and fewer cardiovascular events (adjusted HR, 0.67, 95% CI 0.54-0.83; P < 0.001) during median 14.7 years' follow-up. However this study was non-randomized and selection bias could have contributed to the favorable post-surgical outcome.PubMedCrossRefGoogle Scholar
  72. 72.••
    Rider OJ, Francis JM, Ali MK, Petersen SE, Robinson M, Robson MD, et al. Beneficial cardiovascular effects of bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54(8):718–26. The first rigorous imaging assessment of myocardial structure and function pre and postweight loss, comparing 30 otherwise healthy obese subjects who underwent cardiac MRI before and 1 year after significant weight loss. Both dietary and surgical weight loss led to significant decreases in biventricular mass, end-diastolic volume, and diastolic dysfunction. This illustrates both the potential for weight loss to significantly alter the adverse structural effects of obesity and the utility of MRI in evaluating these changes.PubMedCrossRefGoogle Scholar
  73. 73.
    Kopp HP. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc. 2003;23(6):1042–7.CrossRefGoogle Scholar
  74. 74.
    Luaces M, Cachofeiro V, García-Muñoz-Najar A, Medina M, González N, Cancer E, et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012;65(1):14–21.PubMedCrossRefGoogle Scholar
  75. 75.
    Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbély Y, Beglinger C. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy—a prospective randomized trial. Surg Obes Relat Dis. 2011;7(5):561–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Ikonomidis I, Mazarakis A, Papadopoulos C, Patsouras N, Kalfarentzos F, Lekakis J, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25(2):439–47.PubMedCrossRefGoogle Scholar
  77. 77.
    Le Roux CW, Patterson M, Vincent RP, Hunt C, Ghatei MA, Bloom SR. Postprandial plasma ghrelin is suppressed proportional to meal calorie content in normal-weight but not obese subjects. J Clin Endocrinol Metab. 2005;90(2):1068–71.PubMedCrossRefGoogle Scholar
  78. 78.
    Willens HJ, Chakko SC, Byers P, Chirinos JA, Labrador E, Castrillon JC, et al. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. Am J Cardiol. 2005;95(12):1521–4.PubMedCrossRefGoogle Scholar
  79. 79.
    Lee W-J, Chen C-Y, Chong K, Lee Y-C, Chen S-C, Lee S-D. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):683–90.PubMedCrossRefGoogle Scholar
  80. 80.
    Pournaras DJ, Le Roux CW. Ghrelin and metabolic surgery. Int J Peptides. 2010;(217267):1–5.Google Scholar
  81. 81.
    Garza CA, Pellikka PA, Somers VK, Sarr MG, Collazo-Clavell ML, Korenfeld Y, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105(4):550–6.PubMedCrossRefGoogle Scholar
  82. 82.
    Rajapurohitam V, Gan XT, Kirshenbaum LA, Karmazyn M. The obesity-associated peptide leptin induces hypertrophy in neonatal rat ventricular myocytes. Circ Res. 2003;93(4):277–9.PubMedCrossRefGoogle Scholar
  83. 83.
    Perego L, Pizzocri P, Corradi D, Maisano F, Paganelli M, Fiorina P, et al. Circulating leptin correlates with left ventricular mass in morbid (grade III) obesity before and after weight loss induced by bariatric surgery: a potential role for leptin in mediating human left ventricular hypertrophy. J Clin Endocrinol Metab. 2005;90(7):4087–93.PubMedCrossRefGoogle Scholar
  84. 84.
    Leichman J, Wilson E, Scarborough T, Aguilar D, Miller C, Yu S, et al. Dramatic reversal of derangements in muscle metabolism and left ventricular function after bariatric surgery. Am J Med. 2008;121(11):966–73.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Rider OJ, Petersen SE, Francis JM, Ali MK, Hudsmith LE, Robinson MR, et al. Ventricular hypertrophy and cavity dilatation in relation to body mass index in women with uncomplicated obesity. Heart. 2010;97(3):203–8.PubMedCrossRefGoogle Scholar
  86. 86.
    Kanoupakis E, Michaloudis D, Fraidakis O, Parthenakis F, Vardas P, Melissas J. Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg. 2001;11(5):552–8.PubMedCrossRefGoogle Scholar
  87. 87.
    Di Bello V, Santini F, Di Cori A, Pucci A, Talini E, Palagi C, et al. Effects of bariatric surgery on early myocardial alterations in adult severely obese subjects. Cardiology. 2008;109(4):241–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Zuber M, Kaeslin T, Studer T, Erne P. Weight loss of 146 kg with diet and reversal of severe congestive heart failure in a young, morbidly obese patient. Am J Cardiol. 1999;84(8):955–6.PubMedCrossRefGoogle Scholar
  89. 89.
    Iyengar S, Leier C. Rescue bariatric surgery for obesity-induced cardiomyopathy. Am J Med. 2006;119(12):e5–6.PubMedCrossRefGoogle Scholar
  90. 90.
    Ristow B, Rabkin J, Haeusslein E. Improvement in dilated cardiomyopathy after bariatric surgery. J Card Fail. 2008;14(3):198–202.PubMedCrossRefGoogle Scholar
  91. 91.
    Samaras K, Connolly SM, Lord RV, Macdonald P, Hayward CS. Take heart: bariatric surgery in obese patients with severe heart failure. Two case reports. Heart Lung Circ. 2012;21(12):847–9.PubMedCrossRefGoogle Scholar
  92. 92.
    Gill RS, Karmali S, Nagandran J, Frazier HO, Sherman V. Combined Ventricular Assist Device Placement with adjustable gastric Band (VAD-BAND): a promising new technique for morbidly obese patients awaiting potential cardiac transplantation. J Clin Med Res. 2012;4(2):127–9.PubMedCentralPubMedGoogle Scholar
  93. 93.
    Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol. 1985;55(6):783–6.PubMedCrossRefGoogle Scholar
  94. 94.
    Alpert MA, Terry BE, Mulekar M, Cohen MV, Massey CV, Fan TM. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol. 1997;80(6):736–40.PubMedCrossRefGoogle Scholar
  95. 95.
    McCloskey CA, Ramani GV, Mathier MA, Schauer PR, Eid GM, Mattar SG, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007;3(5):503–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Ramani GV, McCloskey C, Ramanathan RC, Mathier MA. Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure. Clin Cardiol. 2008;31(11):516–20.PubMedCrossRefGoogle Scholar
  97. 97.
    Alsabrook GD, Goodman HR, Alexander JW. Gastric bypass for morbidly obese patients with established cardiac disease. Obes Surg. 2006;16(10):1272–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Heart and Vascular Institute, Section of Heart FailureClevelandUSA
  2. 2.Endocrinology and Metabolism InstituteClevelandUSA

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