Preoperative risk factors associated with left ventricular dysfunction after bariatric surgery

Area of Science:

• Cardiology
• Obesity Medicine
• Bariatric Surgery

Background:

• Severe obesity is linked to left ventricular (LV) dysfunction.
• Bariatric surgery improves obesity but may not fully restore cardiac function in all patients.
• Identifying patients at risk for persistent LV dysfunction post-surgery is crucial.

Purpose of the Study:

• To assess if preoperative echocardiography and inflammatory protein levels can identify patients with severe obesity at high risk for LV dysfunction after bariatric surgery.
• To evaluate the impact of Roux-en-Y gastric bypass on LV mechanics and inflammatory markers.

Main Methods:

• Prospective evaluation of 75 patients with severe obesity undergoing Roux-en-Y gastric bypass.
• Preoperative and 1-year postoperative assessment of LV mechanics (midwall shortening [MWS], global longitudinal strain [GLS]) via echocardiography.
• Measurement of preoperative inflammatory proteins: high-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), and calprotectin.

Main Results:

• Bariatric surgery improved BMI, GLS, and reduced hsCRP, calprotectin, and SAA.
• MWS remained unchanged, with 35% of patients showing impaired MWS at 1-year follow-up.
• A preoperative risk index (sex, hypertension, ejection fraction [EF], hsCRP/SAA) predicted low 1-year MWS with high accuracy (AUC ~0.80).

Conclusions:

• A significant proportion of patients with severe obesity experience persistent impaired LV midwall mechanics 1 year after bariatric surgery.
• Preoperative assessment including echocardiography (EF) and inflammatory markers (hsCRP, SAA) can identify high-risk individuals.
• Women, hypertensive patients, and those with elevated inflammatory markers and reduced EF are at higher risk for impaired LV mechanics post-surgery.