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


OBJECTIVE
The 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.


METHODS
This 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.


RESULTS
Bariatric 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).


CONCLUSIONS
Bariatric 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.
The Department of Surgery and Cancer, Imperial College London, 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.
Ravi
R
Aggarwal
The Department of Surgery and Cancer, Imperial College London, 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.|Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
Leanne
L
Harling
The Department of Surgery and Cancer, Imperial College London, 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.|Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, UK.
Evangelos
E
Efthimiou
The Department of Surgery and Cancer, Imperial College London, 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.
Ara
A
Darzi
The Department of Surgery and Cancer, Imperial College London, 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.|Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
Thanos
T
Athanasiou
The Department of Surgery and Cancer, Imperial College London, 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. h.ashrafian@imperial.ac.uk.|Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, UK. h.ashrafian@imperial.ac.uk.
Hutan
H
Ashrafian
D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D057791:Cardiac Imaging Techniques / Q000379:methods / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology*; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Bariatric surgery; Cardiac function; Cardiac structure; Imaging; Metabolic surgery; Obesity cardiomyopathy