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

Authors
  • Aggarwal, Ravi1
  • Harling, Leanne1, 2
  • Efthimiou, Evangelos1, 3
  • Darzi, Ara1
  • Athanasiou, Thanos1, 2
  • Ashrafian, Hutan1, 3
  • 1 Imperial College London, The Department of Surgery and Cancer, 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 , London (United Kingdom)
  • 2 Imperial College Healthcare NHS Trust, Department of Cardiothoracic Surgery, London, UK , London (United Kingdom)
  • 3 Chelsea and Westminster Hospital, Department of Bariatric Surgery, London, UK , London (United Kingdom)
Type
Published Article
Journal
Obesity Surgery
Publisher
Springer-Verlag
Publication Date
Sep 02, 2015
Volume
26
Issue
5
Pages
1030–1040
Identifiers
DOI: 10.1007/s11695-015-1866-5
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundObesity 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.ObjectivesThe 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.MethodsThis 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.ResultsBariatric 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).ConclusionsBariatric 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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