bariatric surgery – ABC CARDIOL

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Review Article

Impact of Obesity and Bariatric Surgery in the Outcome of Patients with Heart Failure

Ricardo Mourilhe-Rocha et al. Nathália Felix Araujo Salvino

Abstract

Currently, the association between obesity and heart failure (HF) is increasingly known. Patients with advanced obesity who suffer from HF without an identifiable cause can be diagnosed as having obesity-associated cardiomyopathy. Although data suggest that obesity may reduce mortality in HF, weight loss, especially in the presence of morbid obesity, reduces symptoms and improves the quality of life of those patients.

Bariatric surgery is the major treatment available for sustained weight loss in morbid obesity. Observational studies have demonstrated an improvement in ventricular structure and function of morbidly obese patients with HF who underwent that procedure.

Thus, despite the risks, bariatric surgery should be considered for patients with HF, because of its potential for reducing associated comorbidities and improving quality of life and functional capacity, in addition to making eligible for heart transplantation those excluded due to high body mass index.

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Artigo Original

Left ventricular diastolic function in morbidly obese patients in the preoperative for bariatric surgery

Irlaneide da Silva Tavares et al. Antonio Carlos Sobral Sousa Raimundo Sotero Menezes Filho Manuel Hermínio de Aguiar-Oliveira … José Augusto Barreto-Filho Amanda Ferreira de Brito Joselina Luzia Menezes Oliveira

BACKGROUND: Obesity is a chronic and multifactorial disease, associated with increased cardiovascular risk, especially diastolic heart failure. OBJECTIVE: To evaluate left ventricular diastolic function in morbidly obese patients in the pre-operative for bariatric surgery, correlating it with cardiovascular risk factors and heart structure. METHODS: This is a cross-sectional study with 132 patients eligible for bariatric surgery submitted to transthoracic echocardiography assessment and of cardiovascular risk factors, as follows: 97 women (73.5%), mean age 38.5 ± 10.5 years and BMI of 43.7 ± 7.2 kg / m². Patients were divided into three groups: 61 with normal diastolic function, 24 with mild diastolic dysfunction and 47 with moderate/severe diastolic dysfunction, of which 41 with moderate diastolic dysfunction (pseudonormal pattern) and six with severe diastolic dysfunction (restrictive pattern). RESULTS: Hypertension, age and gender were different in the groups with diastolic dysfunction. Groups with dysfunction had higher left atrial diameter, left ventricular diameter, left atrial volume in four and two chambers, left atrial volume index and left ventricular mass index corrected for body surface area and height. CONCLUSION: The high frequency of left ventricular diastolic dysfunction in the preclinical phase in morbidly obese patients justifies the need for careful echocardiographic assessment, aiming at identifying individuals at higher risk, so that early intervention measures can be carried out.

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Artigo Original

Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome

Francisco das Chagas Monteiro Júnior et al. Wellington Santana da Silva Júnior Natalino Salgado Filho Pedro Antônio Muniz Ferreira … Gutenberg Fernandes Araújo Natália Ribeiro Mandarino José Bonifácio Barbosa Joyce Santos Lages José de Ribamar Oliveira Lima Carolina Cipriano Monteiro

BACKGROUND: Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE: The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS: Thirty-five (35) patients who underwent surgical Roux’s Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8±11.1 years and a mean BMI of 45.0±6.2 Kg/m². During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS: Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4±15 months after surgery, a reduction of mean BMI to 28.3±5.0 Kg/m² and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION: MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.

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Artigo Original

Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery

Luciana de Cerjat Bernardes P. Cunha et al. Cláudio L. Pereira da Cunha Admar Moraes de Souza Nelson Chiminacio Neto … Ricardo Soares Pereira Henrique Lacerda Suplicy

OBJECTIVE: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery. METHODS: Twenty-three patients (19 women = 82.6%) were studied. Mean age was 37.9 years. All subjects had Class III or Class II obesity with comorbidity and were submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively, in 6 months and 3 years after surgery. RESULTS: Preoperatively, the mean weight and blood pressure (BP) were respectively 128.7± 25.8 kg and 142.2 ± 16.2 / 92.2 ± 10.4 mmHg. Postoperatively, they showed important body weight reduction in 6 months (97.6 ± 18.3 kg) and 3 years (83.6 ± 13.5 kg), and BP reduction in 6 months (128.5 ± 16.1/80.7 ± 9.9 mmHg) that remain stable in 3rd year. On echocardiogram, preoperatively, there was hypertrophy of the septum and posterior wall associated with normal diastolic dimension; the predominant LV geometric pattern was concentric remodeling (74%). At six months, thinning of the ventricular septum and LV posterior wall, and increase in LV diastolic dimension were demonstrated. At 3rd year, the predominant LV pattern was normal (69%), with reduction of LV mass and LV mass/height² index. We noticed improved diastolic function, with an increased E/A ratio and a decreased LV isovolumic relaxation time. The Myocardial Performance Index was obtained retrospectively in 13 patients and improved in 6 months. There was an increase of the ejection time in 6 months and an elevation of the ejection fraction in 3rd year, suggesting improvement of the LV systolic function. CONCLUSION: The weight loss obtained with bariatric surgery promotes both structural and functional myocardial changes that improve cardiac performance.

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Impact of Obesity and Bariatric Surgery in the Outcome of Patients with Heart Failure

Abstract

Left ventricular diastolic function in morbidly obese patients in the preoperative for bariatric surgery

Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome

Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery

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