Structural and Functional Cardiac Reverse Remodeling After Bariatric Surgery: A Prospective Comparison of Sleeve...

Area of Science:

• Cardiology
• Bariatric Surgery
• Obesity Medicine

Background:

• Obesity causes cardiac remodeling, including left ventricular hypertrophy and dysfunction.
• Bariatric surgery can reverse cardiac remodeling, but differences between procedures and drivers of recovery are unclear.

Purpose of the Study:

• To compare structural and functional cardiac recovery after sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB).
• To determine if weight loss, metabolic changes, or inflammatory mechanisms drive cardiac recovery post-bariatric surgery.

Main Methods:

• Prospective observational study of 100 adults with severe obesity undergoing SG or RYGB.
• Echocardiography with speckle-tracking assessed left ventricular mass index (LVMI), epicardial adipose tissue (EAT), and global longitudinal strain (GLS) at baseline and 6 months.
• Multivariable regression identified predictors of structural (ΔLVMI) and functional (ΔGLS) improvement.

Main Results:

• Both SG and RYGB improved cardiac parameters, but RYGB led to greater reductions in BMI, HbA1c, and C-reactive protein (CRP).
• RYGB showed more pronounced structural reverse remodeling, with greater decreases in LVMI and EAT thickness.
• Global longitudinal strain (GLS) improved in both groups, independently associated with baseline GLS, reduced LV mass, and improved HbA1c and CRP, not surgical type.

Conclusions:

• Bariatric surgery significantly reverses cardiac remodeling in severe obesity.
• RYGB promotes greater structural cardiac regression, but myocardial functional improvement (GLS) is primarily linked to metabolic and inflammatory improvements, not the surgical technique itself.
• Cardiac recovery is an integrated process involving structural, metabolic, and inflammatory restoration, extending beyond weight loss alone.