Abstract 3146: Reverse Cardiac Remodeling 2 Years After Marked Weight Loss From Gastric Bypass Surgery
Background: Left ventricular (LV) hypertrophy is common in obesity and has been proposed as a mechanism that might contribute to the development of heart failure. Although bariatric surgery is being performed with increasing frequency, only limited data are available on the cardiac effects of surgically-induced weight loss.
Methods: We prospectively studied 602 severely obese patients 2 years after randomization to nonsurgical therapy (NonSurg, n = 316) or Roux-en-Y gastric bypass surgery (GBS, n = 285). We measured LV mass echocardiographically using Teicholz and area-length (A-L) methods. We investigated the association of various clinical parameters with LV mass using linear regression models.
Results: At 2 years, GBS patients lost an average of 44.4 kg vs. xx kg in the NonSurg group (p < 0.0001). Systolic blood pressure decreased by 8.1 vs. 1.4 mmHg in GBS compared to NonSurg (p < 0.0001). LV mass (Teicholz) decreased by 32.4 ± 51.1g in GBS (p < 0.0001) and 8.0 ± 51.4 g in NonSurg (p = 0.01). Findings were similar for the A-L method with a decrease of 31.2 ± 44.4 g (p < 0.0001) vs. 3.2 ± 43.3 g (p = ns) in GBS and NonSurg, respectively. A concentric pattern of LV remodeling was present in 64 vs. 76% of GBS and NonSurg patients at baseline. The frequency of concentric geometry declined by 8% in GBS but increased by 7% in NonSurg at 2 years. The decrease in LV mass in the GBS subjects resulted from both reductions in LV wall thickness and LV diameter. In age and sex adjusted modeling, weight (t statistic = 11.8), BMI (t statistic = 9.1), body surface area (t statistic = 11.8), systolic BP (t statistic = 7.1) and cardiac output (t statistic = 5.2) were positively correlated with LV mass while treadmill time had a negative correlation (t statistic = −4.8, p < 0.0001 for all).
Conclusion: In this large, prospective study of severely obese patients we find a significant decrease in LV mass and a reduced frequency of concentric remodeling 2 years after bariatric surgery. The observed reduction in LV mass is greater than what would be expected for the reduction in blood pressure alone. These findings support the notion that GBS may lower long-term cardiovascular risk.