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

Abstract

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.

Objectives: 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.

Keywords: Bariatric surgery; Cardiac function; Cardiac structure; Imaging; Metabolic surgery; Obesity cardiomyopathy.