Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery.
OBJECTIVE
Cardiac adaptation to obesity includes both structural and functional changes in the heart. The therapeutic option of last resort for morbidly obese patients is bariatric surgery. This study aims to assess the anatomical functional changes in the heart for a Spanish cohort of morbidly obese patients, as well as changes after bariatric surgery.


METHODS
Patients referred for bariatric surgery were prospectively included. In each case, a transthoracic echocardiography, electrocardiogram, and blood tests were performed before the procedure and repeated 1 year after surgery.


RESULTS
Forty-one patients completed the 1-year follow-up. Of these, 82.9% were female. Mean age was 40.2±9.6 years. Prior to surgery, mean body mass index was 47.41 kg/m(2), decreasing to 30.43 kg/m(2) after the procedure. Before surgery, cardiac remodeling was present in 70.7%, most frequently in the form of eccentric hypertrophy (34.1%). At 1-year follow-up, 58.5% showed a normal left ventricular geometric pattern (P=.02). Mitral inflow E/A ratio changed from 1.14 to 1.43 (P<.001). Nevertheless, early mitral velocity measured by Doppler tissue decreased (P=.06).


CONCLUSIONS
In morbidly obese patients referred for bariatric surgery, cardiac remodeling is highly prevalent, in most cases in an eccentric manner. Weight loss achieved by bariatric surgery is accompanied by significant improvements in left ventricular structure. Nevertheless, the damage in diastolic function may be permanent despite weight loss.
Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España. mluaces.hflr@salud.madrid.org
María
M
Luaces
Victoria
V
Cachofeiro
Alejandro
A
García-Muñoz-Najar
Manuel
M
Medina
Noemí
N
González
Emilia
E
Cancer
Azucena
A
Rodríguez-Robles
Gloria
G
Cánovas
Alfonso
A
Antequera-Pérez
D000328:Adult; D000465:Algorithms; D050110:Bariatric Surgery; D015992:Body Mass Index; D006332:Cardiomegaly / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D009206:Myocardium / Q000473:pathology*; D009767:Obesity, Morbid / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D016277:Ventricular Function, Left; D055815:Young Adult