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

Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Johannes Just Hjertaas, Knut Matre, Dana Cramariuc, Lisa M D Grymyr, Saied Nadirpour, Eva Gerdts, Bjørn G Nedrebø, Johannes Just Hjertaas, Knut Matre, Dana Cramariuc

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.

Clinicaltrialsgov identifier: NCT01533142, 15 February 2012.

Keywords: Bariatric surgery; Echocardiography; Left ventricular function; Obesity.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
(A) LV geometry (normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy) preoperatively (left diagram) and 1 year after bariatric surgery (right diagram). (B) Patterns of LV mechanics (normal MWS and GLS, low MWS with normal GLS, normal MWS with low GLS, and combined low MWS and low GLS) preoperatively (left diagram) and 1 year after bariatric surgery (right diagram)
Figure 2
Figure 2
Changes in LV size and mechanics illustrated in women (top) and men (bottom) preoperatively (left illustration) and 1 year after bariatric surgery (right illustration). Changes in LV GLS are depicted with blue arrows, and in LV MWS with red arrows. The length of the arrows illustrates the magnitude of the changes
Figure 3
Figure 3
Sex-specific improvement in LV myocardial dysfunction during follow-up. The P-value indicates a significant difference between women and men at the respective visit
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9241572/bin/oeab024f5.jpg

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