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Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Structure and Function in Obese Patients With Heart Failure
Xiao-Yan Jia1, Rui-Jia Lian2,3, Bao-Dong Ma4
1Department of Medical Record Management,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China.
Insights
Laparoscopic sleeve gastrectomy (LSG) significantly improves cardiac structure and function in obese patients with heart failure (HF). This bariatric surgery effectively reduces heart size and enhances left ventricular function across all HF types, particularly benefiting those with heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Bariatric Surgery
- Obesity Medicine
Background:
- Obesity is a major risk factor for heart failure (HF).
- Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure for weight loss.
- The impact of LSG on cardiac structure and function in obese patients with HF requires further investigation.
Purpose of the Study:
- To evaluate the effects of LSG on cardiac structure and function in obese patients with HF.
- To compare the efficacy of LSG in obese patients with different types of HF (preserved, mildly reduced, and reduced ejection fraction).
Main Methods:
- A study involving 33 obese patients with HF who underwent LSG.
- Echocardiographic parameters were assessed preoperatively and at 3, 6, and 12 months post-LSG.
- Patients were categorized into HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) subgroups for comparative analysis.
Main Results:
- LSG led to significant reductions in BMI, body surface area, waist and hip circumference, and body fat content.
- Postoperative echocardiography showed significant decreases in left atrial diameter, right atrial and ventricular dimensions, interventricular septal thickness, and left ventricular volumes.
- Left ventricular fractional shortening and ejection fraction (LVEF) significantly improved in all patient groups post-LSG, with the HFrEF group showing the most pronounced improvements in several cardiac structural and functional parameters.
Conclusions:
- LSG effectively reduces body weight and improves cardiac function in obese patients with HF.
- The procedure reverses cardiac chamber enlargement and enhances left ventricular systolic function.
- LSG demonstrates efficacy across all HF types, with particularly notable benefits for patients with HFrEF.
Abstract:
Objective To investigate the effects of laparoscopic sleeve gastrectomy(LSG)on the cardiac structure and function in obese patients with heart failure(HF)and compare the efficacy of LSG across obese patients with different HF types.Methods This study included 33 obese patients with HF who underwent LSG.The clinical indicators were compared between before operation and 12 months after operation.Repeated measures analysis of variance was employed to evaluate the changes in echocardiographic parameters before operation and 3,6,and 12 months after operation.Patients were allocated into a HF with preserved ejection fraction group(n=17),a HF with mildly reduced ejection fraction group(n=5)and a HF with reduced ejection fraction(HFrEF)group(n=11)based on left ventricular ejection fraction(LVEF)before operation for subgroup analyses of the effects of LSG on the cardiac structure and function of obese patients with HF.The paired samples t-test was conducted to assess the degree of cardiac structural and functional alterations after LSG.Results The 33 patients included 69.7% males,with an average age of(35.3±9.9)years,and a body mass index(BMI)of(51.2±9.8)kg/m2.The median follow-up was 9.0(5.0,13.3)months.Compared with the preoperative values,the postoperative BMI(P=0.002),body surface area(BSA)(P=0.009),waist circumference(P=0.010),hip circumference(P=0.031),body fat content(P=0.007),and percentage of patients with cardiac function grades Ⅲ-IV(P<0.001)decreased.At the 12-month follow-up left atrial diameter(P=0.006),right atrial long-axis inner diameter(RAD1)(P<0.001),right atrial short-axis inner diameter(RAD2)(P<0.001),right ventricular inner diameter(P=0.002),interventricular septal thickness at end-diastolic(P=0.002),and left ventricular end-diastolic volumes(P=0.004)and left ventricular end-systolic volumes(P=0.003) all significantly reduced compared with preoperative values.Additionally,left ventricular fractional shortening and LVEF improved(both P<0.001).Subgroup analyses revealed that cardiac structural parameters significantly decreased in the HF with preserved ejection fraction,HF with mildly reduced ejection fraction,and HFrEF subgroups compared with preoperative values.Notably,the HFrEF group demonstrated the best performance in terms of left atrial diameter(P=0.003),left ventricular inner diameter at end-diastole(P=0.008),RAD1(P<0.001),RAD2(P=0.004),right ventricular inner diameter(P=0.019),left ventricular end-diastolic volume(P=0.004)and left ventricular end-systolic volume(P=0.001),cardiac output(P=0.006),tricuspid regurgitation velocity(P=0.002),and pulmonary artery systolic pressure(P=0.001) compared to preoperatively.Postoperative left ventricular fractional shortening(P<0.001,P=0.003,P<0.001)and LVEF(P<0.001,P=0.011,P=0.001)became higher in all the three subgroups than the preoperative values.Conclusions LSG decreased the body weight,BMI,and BSA,improved the cardiac function grade,reversed the enlargement of the left atrium and left ventricle,reduced the right atrium and right ventricle,and enhanced the left ventricular systolic function.It was effective across obese patients with different HF types.Particularly,LSG demonstrates the best performance in improving the structures of both atria and ventricles in obese patients with HFrEF.
