Impact of obesity and surgical weight reduction on cardiac remodeling

BACKGROUND: the implication of obessity on cardiometabolic risk factors and incident diabetes has been previously demonstrated, but the impact of weight changes on cardiac structure independent of obesity-related comorbidities has not been extensively studied AIM: to study impact of obesity and surgical weight reduction on cardiac structure. PATIENTS AND METHODS: fifty two patients withbody mass index (BMI) ≥40 kg/m(2), free of previous or overt cardiac risk factors and diseases were included, all patients underwent bariatric surgery; Conventional echocardiography (2D, M-Mode, Doppler), tissue Doppler velocity (TDI), strain and speckle tracking echocardiography for left and right ventricles were performed before and 6 m after surgery. RESULTS: mean age was 38.2 ± 5.6, BMI 42.3 ± 3.4 kg/m(2), 65% were female and 35% were male. 6 months postopeatively; there was significant increase of left ventricular end systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV) from 66.57 ± 22 to 37.2 ± 12 p < 0.001, and 169.4 ± 43.2 to 120.36 ± 19.6 ml with p < 0.001 respectively and increased ejection fraction (EF%) from 59 ± 8 to 67 ± 7 ml p < 0.001, significant reduction in left ventricular mass index (LVMI) from 143 ± 11 to 95.5 ± 7gm/m(2) p < 0.001. Significant increase in right ventricular systolic area (RVSA) from 16.3 ± 4.1 to 10.1 ± 2.7 cm(2) p < 0.001 but was insignificant in right ventricular diastolic area (RVDA) from 30.2 ± 1.5 to 26.7 ± 2 cm(2) p = 0.05, fraction area change (FAC) from 49.5 ± 2.1 to 52 ± 1.2% p = 0.7, Tricuspid annular plane systolic exertion (TAPSE) from 20.3 ± 2.8to22.6 ± 3.5 mm, p = 0.56and pulmonary arterty systolic pressure (PASP) from 32.2 ± 5.2 to 29.2 ± 2.1 mmHg, p = 0.81.Early tissue Doppler diastolic velocity (Em) of the LV increased from 7.1 ± 2.1 to12 ± 3.5 p < 0.001 and that of RV from 6.2 ± 2.8 to 9.2 ± 1.4, p = 0.05 and tissue Doppler strain of the LV and RV invrased from −16.1 ± 2.5 to −22.8 ± 3.1, p < 0.001, −11.2± 2.6 to −17.3 ± 3.4, p < 0.001 respectively. Left ventricular longtiduinal systolic strain (LVLPSS) increased from −17.2 ± 2.1 to −22.7 ± 3.9 p < 0.001 and right ventricular longtiduinal systolic strain (RVLPSS) increased from −12.8 ± 1.5 to −18.1 ± 2.7 p < 0.001. CONCLUSION: Obesity adversely affects cardiac function independent of obesity-related comorbidities .Weight reduction significantly increase the systolic and diastolic function of both ventricles.