Endocrine Abstracts

Introduction: Obesity is a chronic disease whose association with increased cardiovascular morbidity and mortality, including heart failure, is well established. Not only is obesity intricately connected with an increased prevalence of concurrent risk factors, such as coronary artery disease, hypertension, diabetes mellitus, and obstructive sleep apnea, but it also exerts a direct impact on myocardial structure and pump performance. Over time, prolonged obesity fosters cardiac remodeling, marked by left ventricle hypertrophy, cardiac fibrosis, and diastolic dysfunction, culminating in the progression to manifest heart failure. The intricate interplay between obesity and cardiovascular health is underscored by these structural and functional alterations in the heart. Bariatric surgery emerges as a highly effective intervention for obesity, exhibiting a remarkable remission rate of associated comorbidities, including cardiac dysfunction. Notably, gastric bypass surgery has demonstrated significant benefits in the reversal of left ventricle remodeling, preservation of both left and right ventricle function, along concomitant weight loss.

Material and methods: Prospective study comparing pre- and post-surgical echocardiograms of 38 obese patients submitted to bariatric surgery.

Results: After 21 [16-30] months, BMI, waist circumference, and fat mass percentage decreased by 31.7% (P<0.001), 20.9% (P<0.001) and 41.8%, (P<0.001), respectively, with remission of Diabetes mellitus, dyslipidemia, and obstructive sleep apnea of 82.4% (P<0.001), 36.1% (P<0.001) and 48.5%, (P<0.001). We observed a reduction in ventricular hypertrophy (mainly eccentric) from 36.4% to 13.2%, P=0.004, due to a reduction in left ventricle mass/heigh^2.7 (-13.9%, P<0.001), septal wall thickness (-10.9%, P<0.001), posterior wall thickness (-7.3%, P=0.007), and relative wall thicknesses (-6.5%, P=0.017), without a significant volumetric change. Changes in both BMI and abdominal circumference were associated with the described shifts in septal wall thickness (r=0.415, P<0.001 and 0.428, P<0.001), posterior wall thickness (r=0.314, P=0.006 and r=0.377, P=0.001), and left ventricle mass/heigh^2.7 (r=0.336, P=0.003 and r=0.309, P=0.007). No association was observed between fat mass percentage. There were no significant differences in left ventricle function (ejection fraction, fractional shortening, nor cardiac output). Despite an improvement in E/A of 25.4% (P=0.005), there was no difference in the prevalence of diastolic disfunction (31.6% vs 28.9%, P=1.000).

Conclusions: Weight loss following bariatric surgery had a positive effect in left ventricle remodeling, a hallmark of obesity-related cardiomyopathy.