CHANGES IN METABOLIC PROFILE, CARDIAC STRUCTURE AND FUNCTION FOLLOWING BARIATRIC SURGERY

Abstract Background Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. It is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure. Bariatric surgery has been proven to be the most effective long–term weight management treatment. Objective Aim of our study was to investigate the changes in both anthropometric and metabolic parameters and in cardiac structure and function after bariatric surgery. Methods Fourty six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The insulin resistance has been assessed by HOMA–IR. Results As expected, an improvement in the anthropometric and metabolic profile was observed in all the patients treated with bariatric surgery. Six and 12 months after bariatric surgery, there were significant improvements in cardiovascular risk factors, including reduction in both total and LDL–cholesterol levels, systolic and diastolic blood pressure, serum uric acid levels, fasting glycemia and fasting insulin levels, glycated hemoglobin and HOMA–IR values. Similarly, the echocardiogram evaluation showed a significant reduction of the end–diastolic left ventricular volume (P<0.05 and P<0.005, respectively), a significant reduction of the end–systolic left ventricular volume (P=0.003 and P=0.005, respectively) and a significant reduction of interventricular septal thickness and posterior wall thickness. On the other hand, a significant increase in the Ejection Fraction (P<0.001 and P<0.001, respectively) and in the E/A Ratio (P<0.05 and P<0.05, respectively) after bariatric surgery had been observed. Left ventricular mass decreased significantly after bariatric surgery (P<0.001). Conclusions Our data showed an increase of the systol function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.