Structural and Functional Changes in Left and Right Ventricles After Major Weight Loss Following Bariatric Surgery for Morbid Obesity

      Obesity and bariatric surgery have been associated with changes in ventricular function and structure. The aim of the present study was to assess the long-term changes in left ventricular (LV) and right ventricular (RV) function and structure in patients with morbid obesity—body mass index ≥40 kg/m2 or ≥35 kg/m2 with co-morbidities—who had lost weight after bariatric surgery compared to nonsurgical controls. We reviewed 57 patients with morbid obesity who had undergone gastric bypass surgery and who had undergone echocardiography before and after surgery. A reference group (n = 57) was frequency matched for body mass index (±2 kg/m2), gender, age (±2 years), and follow-up duration (±6 months). After a mean follow-up of 3.6 years, the LV mass and LV mass indexed by height had decreased in the patients who had undergone bariatric surgery and had lost weight. In contrast, these measurements had increased in the patients who had not undergone bariatric surgery. The difference between these 2 groups remained significant after adjusting for potential confounders. At follow-up, neither the patients nor controls showed a significant change in ejection fraction, LV myocardial performance index, or RV myocardial performance index. In the study population as a whole, multivariate analysis showed a positive correlation between the change in body weight and ventricular septum thickness (R = 0.33), posterior wall thickness (R = 0.31), LV mass (R = 0.38), RV end-diastolic area (R = 0.22), and estimated RV systolic pressure (R = 0.39), all with p values <0.05. In conclusion, body weight changes in patients with morbid obesity were associated with changes in LV structure independent of improvement in obesity-related co-morbidities, including obstructive sleep apnea. Weight loss improved the RV end-diastolic area and might prevent progression to RV dysfunction.
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        • Poulsen S.H.
        • Jensen S.E.
        • Nielsen J.C.
        • Moller J.E.
        • Egstrup K.
        Serial changes and prognostic implications of a Doppler-derived index of combined left ventricular systolic and diastolic myocardial performance in acute myocardial infarction.
        Am J Cardiol. 2000; 85: 19-25
        • Ozturk O.
        • Ulgen M.S.
        • Tekes S.
        • Ozturk U.
        • Toprak N.
        Influence of angiotensin-converting enzyme I/D gene polymorphism on the right ventricular myocardial performance index in patients with a first acute anterior myocardial infarction.
        Circ J. 2005; 69: 211-215
        • Kaul S.
        • Tei C.
        • Hopkins J.M.
        • Shah P.M.
        Assessment of right ventricular function using two-dimensional echocardiography.
        Am Heart J. 1984; 107: 526-531
        • Scapellato F.
        • Temporelli P.L.
        • Eleuteri E.
        • Corra U.
        • Imparato A.
        • Giannuzzi P.
        Accurate noninvasive estimation of pulmonary vascular resistance by Doppler echocardiography in patients with chronic failure heart failure.
        J Am Coll Cardiol. 2001; 37: 1813-1819
        • Quinones M.A.
        • Waggoner A.D.
        • Reduto L.A.
        • Nelson J.G.
        • Young J.B.
        • Winters Jr, W.L.
        • Ribeiro L.G.
        • Miller R.R.
        A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.
        Circulation. 1981; 64: 744-753
        • Devereux R.B.
        • Casale P.N.
        • Kligfield P.
        • Eisenberg R.R.
        • Miller D.
        • Campo E.
        • Alonso D.R.
        Performance of primary and derived M-mode echocardiographic measurements for detection of left ventricular hypertrophy in necropsied subjects and in patients with systemic hypertension, mitral regurgitation and dilated cardiomyopathy.
        Am J Cardiol. 1986; 57: 1388-1393
        • Yock P.G.
        • Popp R.L.
        Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation.
        Circulation. 1984; 70: 657-662
        • Snedecor G.W.
        • Cochran W.G.
        Statistical Methods. vol XX. Iowa State University Press, Ames, Ohio1989
        • Schillaci G.
        • Pasqualini L.
        • Vaudo G.
        • Lupattelli G.
        • Pirro M.
        • Gemelli F.
        • De Sio M.
        • Porcellati C.
        • Mannarino E.
        Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up.
        Am J Hypertens. 2003; 16: 634-639
        • Ippisch H.M.
        • Inge T.H.
        • Daniels S.R.
        • Wang B.
        • Khoury P.R.
        • Witt S.A.
        • Glascock B.J.
        • Garcia V.F.
        • Kimball T.R.
        Reversibility of cardiac abnormalities in morbidly obese adolescents.
        J Am Coll Cardiol. 2008; 51: 1342-1348
        • Ikonomidis I.
        • Mazarakis A.
        • Papadopoulos C.
        • Patsouras N.
        • Kalfarentzos F.
        • Lekakis J.
        • Kremastinos D.T.
        • Alexopoulos D.
        Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study.
        J Hypertens. 2007; 25: 439-447
        • Alpert M.A.
        • Terry B.E.
        • Mulekar M.
        • Cohen M.V.
        • Massey C.V.
        • Fan T.M.
        • Panayiotou H.
        • Mukerji V.
        Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss.
        Am J Cardiol. 1997; 80: 736-740
        • Karason K.
        • Wallentin I.
        • Larsson B.
        • Sjostrom L.
        Effects of obesity and weight loss on cardiac function and valvular performance.
        Obes Rev. 1998; 6: 422-429
        • Alpert M.A.
        • Singh A.
        • Terry B.E.
        • Kelly D.L.
        • El-Deane M.S.
        • Mukerji V.
        • Villarreal D.
        • Artis A.K.
        Effect of exercise and cavity size on right ventricular function in morbid obesity.
        Am J Cardiol. 1989; 64: 1361-1365
        • de Divitiis O.
        • Fazio S.
        • Petitto M.
        • Maddalena G.
        • Contaldo F.
        • Mancini M.
        Obesity and cardiac function.
        Circulation. 1981; 64: 477-482
        • Mathier M.A.
        • Zhang J.
        • Ramanathan R.C.
        Dramatic functional improvement following bariatric surgery in a patient with pulmonary arterial hypertension and morbid obesity.
        Chest. 2008; 133: 789-792
        • Romero-Corral A.
        • Somers V.K.
        • Pellikka P.A.
        • Olson E.J.
        • Bailey K.R.
        • Korinek J.
        • Orban M.
        • Sierra-Johnson J.
        • Kato M.
        • Amin R.S.
        • Lopez-Jimenez F.
        Decreased right and left ventricular myocardial performance in obstructive sleep apnea.
        Chest. 2007; 132: 1863-1870