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. 2023 Jan;33(1):47-56.
doi: 10.1007/s11695-022-06336-x. Epub 2022 Nov 5.

Normalization of Cardiac Function After Bariatric Surgery Is Related to Autonomic Function and Vitamin D

Sanne M Snelder  1 , Yaar Aga  1 , Lotte E de Groot-de Laat  2 , L Ulas Biter  3 , Manuel Castro Cabezas  4   5 , Nadine Pouw  6 , Erwin Birnie  7 , Bianca Boxma-de Klerk  7 , René A Klaassen  8 , Felix Zijlstra  9 , Bas M van Dalen  10   11
Affiliations

Normalization of Cardiac Function After Bariatric Surgery Is Related to Autonomic Function and Vitamin D

Sanne M Snelder et al. Obes Surg. 2023 Jan.

Abstract

Purpose: Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery.

Methods: Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35-65 years and BMI ≥ 35 kg/m2. Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I.

Results: A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery.

Conclusion: Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction.

Keywords: Autonomic dysfunction; Bariatric surgery; Cardiac dysfunction; Global longitudinal strain; Obesity/obese; Vitamin D.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of patients with completion of or loss to follow-up. DM = diabetes mellitus
Fig. 2
Fig. 2
ROC-curve for the prediction model for cardiac dysfunction post-surgery. Model; combination of SDNN and vitamin D pre-surgery. Area under the curve = 0.81 (95% CI: 0.67–0.95, p = 0.001), sensitivity of 70%, and a specificity of 80%
See this image and copyright information in PMC

References

    1. Global BMIMC, Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–86. doi: 10.1016/S0140-6736(16)30175-1. - DOI - PMC - PubMed
    1. Snelder SM, de Groot-de Laat LE, Biter LU, Castro Cabezas M, Pouw N, Birnie E, et al. Subclinical cardiac dysfunction in obesity patients is linked to autonomic dysfunction: findings from the CARDIOBESE study. ESC Heart Fail. 2020;7(6):3726–3737. doi: 10.1002/ehf2.12942. - DOI - PMC - PubMed
    1. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–313. doi: 10.1056/NEJMoa020245. - DOI - PubMed
    1. Stewart S, MacIntyre K, Hole DJ, Capewell S, McMurray JJ. More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001;3:315–322. doi: 10.1016/S1388-9842(00)00141-0. - DOI - PubMed
    1. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–2693. doi: 10.1056/NEJMoa035622. - DOI - PubMed

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