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THE EFFECT OF BARIATRIC SURGERY IN IMPROVING LEFT VENTRICULAR DIASTOLIC FUNCTION
Renata Petroni, Laura Pezzi, Michele Di Mauro, Settimio Fabrizio Altorio, Silvio Romano,
Angelo Petroni, Maria Penco
University of l’Aquila
Background: The obesity is becoming more and more a worldwide issue (globesity). The main impact
of the obesity is surely on cardiovascular disease. In fact, obese patients have an increased cardiovascular risk, especially for ischemic heart disease and heart failure. The aim of this study is to
evaluate if bariatric surgery allows to improve left ventricular diastolic function.
Methods: From January 2010 to February 2013, 38 obese patients (average BMI 46 ± 8.9) were
scheduled at our outpatient obesity clinic; all these patients underwent bariatric surgery. The prevalence of hypertension was 58%; diabetes 22% and hypercholesterolemia 33%.
Follow up was 100% completed. All the patients were evaluated at baseline and 18 months.Diastolic
function was evaluated with the following parameters: E wave peak, A wave peak, E/A ratio, E deceleration time and E/E’ value.
Results: Among 38 patients before surgery seventeen (45%) showed a diastolic filling pattern of
impaired relaxation (grade I diastolic dysfunction); five (13%) presented a pseudo-normalized filling
pattern (grade II) and sixteen(42%) showed a normal diastolic filling pattern; no one presented a restrictive pattern (grade III).After bariatric surgery five(13% vs 45%; p < 0.001) patients remain with
a grade 1 of diastolic dysfunction; two patients (5%vs 13%; p < 0.01) showed the persistence of
pseudo-normalized filling diastolic pattern and thirty-one patients (86% vs 42%; p < 0.001) presented
a normal filling diastolic pattern.
This variation was correlated also with cardiovascular risk factors; we evaluated if withdrawing therapy for hypertension, diabetes and hypercholesterolemia allowed to improve diastolic filling patterns
with the following results: there is significant statistical difference in the percentage of patients with
hypertension and grade I or grade II of diastolic dysfunction before and after bariatric surgery (88% vs
0%; p < 0.001 and 100% vs 50%; p < 0.001). Among diabetic subjects we have had similar results:
for grade I of diastolic dysfunction 82% vs 20%; p < 0.001 and for grade II of diastolic dysfunction
100% vs 50%; p < 0.001. For hypercholesterolemic subjects with grade I of diastolic dysfunction before and after bariatric surgery this percentage are 80% vs 0%; p < 0.001 and for grade II of diastolic
dysfunction 100% vs 50%; p < 0.001.
Conclusions: Bariatric surgery is effective to improve left ventricular diastolic function, especially in
patients that withdraw therapy for cardiovascular risk factors.