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Bariatric surgeries and cardiac structure and function: Systematic review and network meta-analysis
Xiao-Qian Zhang1,2, Ke-Ning Chen3,4, Zu-Xuan Zhang1,2
1Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Insights
Gastric bypass surgery significantly improves cardiac structure in obese patients, more so than other bariatric procedures. However, no bariatric surgery notably enhanced cardiac function (left ventricular ejection fraction).
Area of Science:
- Cardiology
- Metabolic Surgery
- Obesity Medicine
Background:
- Obesity is a major risk factor for cardiovascular disease.
- Bariatric surgery is an effective obesity treatment, but its cardiac effects vary.
- Understanding the impact of different bariatric procedures on heart health is crucial.
Purpose of the Study:
- To systematically review and perform a network meta-analysis on the effectiveness of bariatric surgeries on cardiac structure and function.
- To compare the effects of various bariatric procedures against each other and non-surgical interventions.
Main Methods:
- A systematic search of PubMed, Web of Science, and EMBASE databases was conducted.
- Included studies compared bariatric surgeries with controls or other surgical methods.
- Outcomes assessed included changes in left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF).
Main Results:
- Gastric bypass significantly reduced LVM and LVMI compared to other bariatric surgeries.
- No significant improvements in left ventricular ejection fraction (LVEF) were observed across any bariatric surgery type.
- Biliopancreatic diversion with duodenal switch resulted in the most substantial reduction in body mass index.
Conclusions:
- Gastric bypass demonstrates superior effectiveness in improving cardiac structure among bariatric surgeries.
- Current evidence does not support significant improvements in cardiac function (LVEF) with any bariatric surgery.
- Further research is needed to elucidate the mechanisms behind these differential effects on cardiac structure and function.
Background:
Obesity, a global health problem, is causally implicated in the development of cardiovascular disease. Bariatric surgeries are effective treatment options for obesity; however, the effectiveness of different bariatric surgeries on cardiac structure and function is not fully understood. We undertook a systematic review and network meta-analysis to comprehensively assess this effectiveness.
Data Source:
PubMed, Web of Science, and EMBASE were searched from their inception until November 11, 2023. Studies that compared bariatric surgeries vis-à-vis non-surgical treatment, placebo, and other bariatric surgeries, as well as reported changes in left ventricular mass or its index (LVM or LVMI) or left ventricular ejection fraction (LVEF), were summarized.
Results:
Total 19 studies (17 cohort studies and 2 randomized controlled trials) and 2012 adults were meta-analyzed. Patients receiving gastric bypass had appreciably lowered LVM (weighted mean difference [WMD]: -43.86 g, 95% confidence interval [CI] -61.09 to -26.63, p < 0.01) and LVMI (standardized mean difference: -0.67, 95% CI -1.03 to -0.32, p < 0.01) compared with other bariatric surgeries. No significant improvement in LVEF was noted across all surgeries. The drop in body mass index was most pronounced for biliopancreatic diversion with duodenal switch (WMD -16.33 kg/m2, 95% CI -21.60 to -11.05, p < 0.01).
Conclusions:
Our findings of this network meta-analysis indicated that gastric bypass proved best for the improvement in cardiac structure, and there was no obvious improvement in cardiac function for all bariatric surgeries. Further studies are required to better understand the differing effectiveness of bariatric surgeries on cardiac structure and function and the underlying molecular mechanisms.
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