BRIDGING THE GAP: A SYSTEMATIC REVIEW OF BARIATRIC SURGERY'S EFFECTS ON CARDIAC HEALTH
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Keywords
bariatric surgery, metabolic surgery, imaging, cardiac activity, cardiac structure, obesity cardiomyopathy.
Abstract
Objective: This study compares preoperative and post-operative cardiac imaging measures to examine the effects of bariatric surgery on heart shape and function in obese patients.
Methodology: Using PubMed, MedLine, Ovid, and Cinhal, this work searched the literature for bariatric, metabolic, weight loss, and obesity surgery as well as echocardiography, MRI, cardiac imaging, cardiac dimensions, & ventricular dimensions. Studies included had an initial follow-up of three months and reported on heart structural and function parameters obtained by MRI or echocardiography. Study excluded had conflicting or no preoperative or postoperative data. The Newcastle-Ottawa scale was used for quality assessment; PRISMA guidelines were followed for statistical analysis, which computed and pooled results using a model of random effects with 95% confidence intervals, weighted mean differences, and DerSimonian & Laird modelling. We looked at inter-study heterogeneity with the I2 statistic.
Results: Bariatric surgery greatly improves a number of cardiac indices, including left atrium diameter (1.967 mm, 95% CI 0.980-2.954), left ventricular end-diastolic volume (13.28 ml, 95% CI 5.22-21.34 ml), as well as left ventricular mass index (11.2, 95% confidence intervals (CI) 8.2-14.1%). Positive increases were noted for the left ventricular ejection fraction (1.198, 95% CI 0.050-2.347) and the E/A ratio (0.189, 95% CI 0.113–0.265).
Conclusion: In obese patients, bariatric surgery has been shown to have beneficial impacts on diastolic function, systolic function, and cardiac structure. The alteration of the enteric cardiac axis may be a contributing factor to these outcomes. However, future research endeavours should prioritize the acquisition of more robust evidence to precisely determine the most effective bariatric procedures for preventing and treating a diverse spectrum of obesity-related cardiac pathologies, in addition to further developing strategies for managing obesity cardiomyopathy.
References
2. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global
Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study.
J Am Coll Cardiol. 2020 Dec 22;76(25):2982–3021.
3. Ashrafian H, le Roux CW, Darzi A, Athanasiou T. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118(20):2091-102.
4. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. Journal of the American College of Cardiology. 2012;59(7):635-43.
5. Kasper EK, Hruban RH, Baughman KL. Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure. The American journal of cardiology. 1992;70(9):921-4.
6. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. New England Journal of Medicine. 2002;347(5):305-13.
7. Pritchett AM, Deswal A, Aguilar D, Foreyt JP, Chan W, Mann DL, et al. Lifestyle modification with diet and exercise in obese patients with heart failure–a pilot study. Journal of obesity & weight loss therapy. 2012;2(2):1.
8. Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database of Systematic Reviews. 2011(10).
9. Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P, Group BWMR. Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics. 2014;114(10):1557-68.
10. Kokkinos A, Alexiadou K, Liaskos C, Argyrakopoulou G, Balla I, Tentolouris N, et al. Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obesity surgery. 2013;23(1):31-8.
11. Alpert MA, Terry BE, Mulekar M, Cohen MV, Massey CV, Fan TM, et al. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. The American journal of cardiology. 1997;80(6):736-40.
12. Bottini PB, Carr AA, Prisant LM, Flickinger FW, Allison JD, Gottdiener JS. Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient. American journal of hypertension. 1995;8(3):221-8.
13. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry: the Framingham Heart Study. Jama. 1991;266(2):231-6.
14. Rider OJ, Lewandowski A, Nethononda R, Petersen SE, Francis JM, Pitcher A, et al. Gender-specific differences in left ventricular remodelling in obesity: insights from cardiovascular magnetic resonance imaging. European heart journal. 2013;34(4):292-9.
15. Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. European heart journal. 2007;28(20):2539-50.
16. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size: physiologic determinants and clinical applications. Journal of the American College of Cardiology. 2006;47(12):2357-63.
17. Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obesity surgery. 2015;25(7):1239-50.
18. Ashrafian H, le Roux CW, Rowland SP, Ali M, Cummin AR, Darzi A, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012;67(5):442-9.
19. Alpert MA, Terry B, Lambert CR, Kelly DL, Panayiotou H, Mukerji V, et al. Factors influencing left ventricular systolic function in nonhypertensive morbidly obese patients, and effect of weight loss induced by gastroplasty. The American journal of cardiology. 1993;71(8):733-7.
20. Alpert MA, Lambert CR, Panayiotou H, Terry BE, Cohen MV, Massey CV, et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. The American journal of cardiology. 1995;76(16):1194-7.
21. Ristow B, Rabkin J, Haeusslein E. Improvement in dilated cardiomyopathy after bariatric surgery. Journal of cardiac failure. 2008;14(3):198-202.
22. Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763-77.
23. Garza CA, Pellikka PA, Somers VK, Sarr MG, Collazo-Clavell ML, Korenfeld Y, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. The American journal of cardiology. 2010;105(4):550-6.
24. Ashrafian H, Athanasiou T, le Roux CW. Heart remodelling and obesity: the complexities and variation of cardiac geometry. BMJ Publishing Group Ltd; 2011. p. 171-2.
25. Rider OJ, Petersen SE, Francis JM, Ali MK, Hudsmith LE, Robinson MR, et al. Ventricular hypertrophy and cavity dilatation in relation to body mass index in women with uncomplicated obesity. Heart. 2011;97(3):203-8.
26. Ashrafian H, Bueter M, Ahmed K, Suliman A, Bloom S, Darzi A, et al. Metabolic surgery: an evolution through bariatric animal models. Obesity Reviews. 2010;11(12):907-20.
27. Ashrafian H, Athanasiou T, Li J, Bueter M, Ahmed K, Nagpal K, et al. Diabetes resolution and hyperinsulinaemia after metabolic Roux‐en‐Y gastric bypass. obesity reviews. 2011;12(5):e257-e72.
28. Li JV, Ashrafian H, Bueter M, Kinross J, Sands C, le Roux CW, et al. Metabolic surgery profoundly influences gut microbial–host metabolic cross-talk. Gut. 2011;60(9):1214-23.
29. Ashrafian H, Darzi A, Athanasiou T. Autobionics: a new paradigm in regenerative medicine and surgery. Regenerative medicine. 2010;5(2):279-88.
30. Ashrafian H, le Roux CW. Metabolic surgery and gut hormones–a review of bariatric entero-humoral modulation. Physiology & behavior. 2009;97(5):620-31.
31. Chatelain P, Robberecht P, De Neef P, Claeys M, Christophe J. Low responsiveness of cardiac adenylate cyclase activity to peptide hormones in spontaneously hypertensive rats. FEBS letters. 1979;107(1):86-90.
32. Ashrafian H, Li JV, Spagou K, Harling L, Masson P, Darzi A, et al. Bariatric surgery modulates circulating and cardiac metabolites. Journal of proteome research. 2014;13(2):570-80.
33. Nikolaidis LA, Mankad S, Sokos GG, Miske G, Shah A, Elahi D, et al. Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion. Circulation. 2004;109(8):962-5.
34. Sokos GG, Nikolaidis LA, Mankad S, Elahi D, Shannon RP. Glucagon-like peptide-1 infusion improves left ventricular ejection fraction and functional status in patients with chronic heart failure. Journal of cardiac failure. 2006;12(9):694-9.
35. Nijhuis J, Van Dielen FM, Buurman WA, Greve JWM. Ghrelin, leptin and insulin levels after restrictive surgery: a 2-year follow-up study. Obesity surgery. 2004;14(6):783-7.
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Dr Muhammad Haider Ali
Resident Surgeon Hayatabad Medical Complex, Peshawar
Dr Sania Malik
Resident Surgeon, Khyber Teaching Hospital, Peshawar
Dr Muhammad Jawad Zahid
Resident Surgeon, Hayatabad Medical Complex, Peshawar
Dr Mashhood Alam Khan
House officer, Hayatabad Medical Complex, Peshawar
Dr Muhammad Saleem
Resident Surgeon, Hayatabad Medical Complex, Peshawar
Dr Shabeer ahmad
Surgical resident Hayatabad Medical Complex, Peshawar
Dr Muhammad Waqas
Resident Surgeon, Hayatabad Medical Complex, Peshawar
Dr Hamza Khan Toru
8Resident medical officer, Hayatabad Medical Complex, Peshawar
Dr Aftab Faheem
Resident Surgeon, Hayatabad Medical Complex, Peshawar
Dr Aisha Farooq
Resident Doctor, Rehman Medical Institute, Peshawar