The impact of weight loss on cardiac structure and function in obese patients.

BACKGROUND: Obesity frequently results in structural and physiologic changes in the cardiovascular system. Whether weight reduction leads to reversal of these changes is not well-established. This investigation sought to identify the effect of a weight reduction program on right and left ventricular structure and function. METHODS: Sixty-two patients presenting to the eating disorders clinic at a single academic institution for weight loss programs were prospectively enrolled. Baseline and follow-up transthoracic echocardiograms were obtained after at least 10% weight reduction or 6 months after baseline echocardiogram. Complete 2-dimensional echocardiograms were performed with M-mode, flow Doppler, and tissue Doppler evaluation. RESULTS: Patients lost an average of 28.2 +/- 3 kg over a period of 266 +/- 36 days. Left ventricular mass decreased significantly from 255.87 +/- 12 to 228 +/- 11 gm. There were no statistically significant changes in contractility or diastolic indices. The ratios of early-to-late diastolic mitral inflow velocities (E/A) increased from 1.30 +/- 0.05 to 1.32 +/- 0.06. The ratio of early mitral flow to early annular velocity (E/Em) also increased from 5.57 +/- 0.22 cm to 5.82 +/- 0.23 cm. Deceleration time increased from 213.26 +/- 5.3 s to 228.47 +/- 5.7 s. CONCLUSIONS: Weight reduction is associated with decrease in left ventricular diastolic size and left ventricular mass. This weight reduction is not associated with statistically significant improvement in systolic or diastolic function.

Effect of comorbidities and medications on left ventricular mass regression after bariatric surgery.

Hypertension, diabetes, and obesity frequently coexist and significantly contribute to cardiovascular morbidity and mortality. Weight loss in obese individuals has been associated with improved blood pressure control and regression in left ventricular (LV) hypertrophy. The authors investigated the impact of comorbidity and medication on clinical and echocardiographic parameters after weight loss in obese patients. Serial echocardiography and clinical data were collected in 62 patients before bariatric surgery and after 6 months or 10% weight loss. Obese patients with diabetes or hypertension had higher baseline LV mass (LVM) (334 + or - 73 g in hypertension and diabetes vs 252 + or - 97 g in hypertension and 219 + or - 75 g in disease-free patients, P = .003; P = .089 for differences in LVM indexed by height), despite the lack of significant differences in body mass index or systolic blood pressure. There were no significant differences in baseline LVM or LVM index related to the medication used to treat hypertension. After weight loss, patients on beta-blocker therapy experienced the most significant LV hypertrophy regression (-76.5 + or - 79.1 g with beta-blockers, -17.8 + or - 43.7 g with diuretics, -4.5 + or - 46.6 g with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and -23.1 + or - 50.9 g in not treated patients, overall P = .538; beta-blockers vs no therapy P < .005; P = .145 for differences in LVM index). Bariatric surgery, combined with a weight loss program, provide substantial weight and LVM reduction regardless of comorbidities or blood pressure changes. beta-Blocker therapy appears to be associated with the greatest LVM regression after weight loss.