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

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Title: The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes
Authors: Aggarwal, R
Harling, L
Efthimiou, E
Darzi, A
Athanasiou, T
Ashrafian, H
Item Type: Journal Article
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.
Issue Date: 1-May-2016
Date of Acceptance: 2-Sep-2015
URI: http://hdl.handle.net/10044/1/38741
DOI: https://dx.doi.org/10.1007/s11695-015-1866-5
ISSN: 1708-0428
Publisher: Springer
Start Page: 1030
End Page: 1040
Journal / Book Title: Obesity Surgery
Volume: 26
Issue: 5
Copyright Statement: The final publication is available at Springer via http://dx.doi.org/10.1007/s11695-015-1866-5
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: DH PO:481818
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Bariatric surgery
Metabolic surgery
Imaging
Cardiac function
Cardiac structure
Obesity cardiomyopathy
LEFT-VENTRICULAR FUNCTION
MORBIDLY OBESE-PATIENTS
GLUCAGON-LIKE PEPTIDE-1
CHRONIC HEART-FAILURE
MAJOR WEIGHT-LOSS
Y GASTRIC BYPASS
2-YEAR FOLLOW-UP
METABOLIC SURGERY
CARDIOVASCULAR FUNCTION
SLEEVE GASTRECTOMY
1103 Clinical Sciences
1117 Public Health And Health Services
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation