Differential Biventricular Strain Recovery With Selective Fibrosis Biomarker Regression After Sleeve Gastrectomy: A...

Obesity injures the heart through hemodynamic, fibrotic, and adipokine pathways, but whether these reverse together or on different timelines after bariatric surgery is unknown. We performed, to our knowledge, the first integrated assessment of biventricular and biatrial cardiovascular magnetic resonance feature-tracking (CMR-FT), fibrosis and adipokine biomarkers, cardiovascular risk, and quality of life after laparoscopic sleeve gastrectomy (LSG), testing whether recovery is uniform or uneven.

In this single-center prospective cohort, 40 patients underwent LSG; 8 were lost to follow-up, leaving 32 (28 with paired CMR; 26 women; aged 36.3 ± 7.6 years; baseline BMI 41.1 ± 4.8 kg/m²) studied before and a median 8.4 months after surgery.

Left ventricular mass declined from 93.3 to 78.9 g (p < 0.001), alongside improved LVGLS (16.0 to 18.6%, p = 0.003), MAPSE (p = 0.004), and LVEF (p = 0.021). RVEF increased (p = 0.013) without parallel change in RVGLS or TAPSE. Left atrial volume index was unchanged, with only a reservoir-strain trend toward improvement (p = 0.059). Only galectin-3 and endotrophin declined (both p < 0.001); FABP4, apelin, and adiponectin were unchanged. NT-proBNP rose (p < 0.001) despite falling blood pressure and improving strain. Metabolic risk factors improved broadly; Framingham risk and all SF-36 domains improved (p < 0.001).

Cardiac reverse remodeling after LSG is measurable but uneven within the first year. LV longitudinal mechanics improved alongside mass regression, whereas RVEF rose without parallel longitudinal change, consistent with afterload reduction rather than intrinsic RV recovery. Fibrosis-linked galectin-3 and endotrophin declined while adipokines remained static, indicating distinct fibrotic and adipokine timelines. The components that respond earliest are those that conventional preoperative assessment overlooks.