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Bariatric Surgery-Induced Cardiac and Lipidomic Changes in Obesity-Related Heart Failure with Preserved Ejection

Deana Mikhalkova1, Sujata R Holman1, Hui Jiang2

  • 1Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA.

Obesity (Silver Spring, Md.)
|December 16, 2017
PubMed

Insights

Gastric bypass surgery improved heart failure symptoms and cardiac function in obese women. Weight loss reduced cardiac mass and liver fat, but cardiac fat and lipid changes were not directly linked to functional improvements.

Area of Science:

  • Cardiology
  • Metabolic Surgery
  • Obesity Medicine

Background:

  • Obesity is a significant risk factor for heart failure with preserved ejection fraction (HFpEF).
  • Myocardial lipid deposition and altered plasma lipidome are implicated in HFpEF pathogenesis.
  • The impact of bariatric surgery on cardiac function and lipid metabolism in HFpEF remains incompletely understood.

Purpose of the Study:

  • To investigate the effects of gastric bypass surgery on myocardial lipid deposition, cardiac function, and plasma lipidome in women with obesity and HFpEF.

Main Methods:

  • A primary cohort of 12 women with HFpEF and obesity underwent echocardiography and magnetic resonance spectroscopy pre- and post-surgery (3 and 6 months).
  • Plasma lipidomic analysis was performed pre-surgery and 3 months post-surgery.
  • A validation cohort of 22 patients confirmed key findings.

Main Results:

  • Gastric bypass surgery led to significant weight loss, reduced Minnesota Living with Heart Failure scores, decreased cardiac mass, and lowered liver fat.
  • Echocardiography showed improved diastolic function (increased e'), but cardiac fat remained unchanged.
  • Weight loss was associated with decreased plasma ceramide and sphingolipid species, yet these changes did not correlate with improvements in cardiac function.

Conclusions:

  • Gastric bypass surgery ameliorates symptoms and improves cardiac remodeling and relaxation in women with obesity-related HFpEF.
  • While surgery impacts the plasma sphingolipidome, improvements in cardiac function are not directly associated with these lipidomic changes or altered myocardial triglyceride content.
  • Cardiac fat deposition and specific lipidomic alterations may not be the primary drivers of obesity-related HFpEF, suggesting alternative therapeutic targets.
Abstract

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