Skip to main content
SpringerLink
Log in

Has the Time Come to Be More Aggressive With Bariatric Surgery in Obese Patients With Chronic Systolic Heart Failure?

  • Management of Heart Failure (T. Meyer, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Obesity is a strong risk factor for the development of heart failure (HF). Diet, exercise, and weight-loss pharmacotherapies have limited potential to achieve significant and sustainable weight loss, especially in patients with symptomatic systolic HF. This review seeks to determine the role of bariatric surgery for patients with systolic HF and obesity.

Recent Findings

Bariatric surgeries such as the laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) represent the most successful long-term strategy for achieving weight loss and diabetes and hypertension remission in the general obese population. These benefits translate to reductions in cardiovascular events and mortality, as well as improvements in myocardial structure and function. There is also now data supporting the safety of LSG or RYGB in patients with systolic dysfunction and a reduction in HF admissions post-operatively.

Summary

Current literature and clinical experience suggest that the most appropriate bariatric surgery candidates with HF are patients aged < 50–60 years, with severely depressed systolic function and NYHA II-III symptoms, who have failed non-surgical strategies and have a high likelihood of future cardiac transplantation candidacy after weight loss. This review seeks to determine the role of bariatric surgery for patients with systolic HF and obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kenchaiah S, Evans JC, Levy D, Wilson PWF, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.

    Article  PubMed  Google Scholar 

  2. Levitan EB, Yang AZ, Wolk A, Mittleman MA. Adiposity and incidence of heart failure hospitalization and mortality: a population-based prospective study. Circ Heart Fail. 2009;2:202–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ho JE, Lyass A, Lee DS, Vasan RS, Kannel WB, Larson MG, et al. Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ Heart Fail. 2013;6:279–86.

    Article  PubMed  Google Scholar 

  4. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;1–8.

  5. • Joyce E, Lala A, Stevens SR, Cooper LB, Abouezzeddine OF, Groarke JD, et al. Prevalence, profile, and prognosis of severe obesity in contemporary hospitalized heart failure trial populations. JACC Heart Fail. 2016;4:923–31. This report describes the BMI distribution in contemporary Heart Failure Network inpatient clinical trials and reveals a high prevalence of obesity in HF. Subjects with BMI ≥ 40 kg/m 2 were younger, more often female, hypertensive, diabetic, and more likely to have HFpEF.

    Article  PubMed  Google Scholar 

  6. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35:1–23.

    Article  PubMed  Google Scholar 

  7. Oreopoulos A, Ezekowitz JA, McAlister FA, Kalantar-Zadeh K, Fonarow GC, Norris CM, et al. Association between direct measures of body composition and prognostic factors in chronic heart failure. Mayo Clin Proc. 2010;85:609–17.

    Article  PubMed  PubMed Central  Google Scholar 

  8. St Peter JV, Hartley GG, Murakami MM, Apple FS. B-type natriuretic peptide (BNP) and N-terminal pro-BNP in obese patients without heart failure: relationship to body mass index and gastric bypass surgery. Clin Chem. 2006;52:680–5.

    Article  CAS  PubMed  Google Scholar 

  9. Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165:55–61.

    Article  PubMed  Google Scholar 

  10. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13–22.

    Article  PubMed  Google Scholar 

  11. Pocock SJ, McMurray JJV, Dobson J, Yusuf S, Granger CB, Michelson EL, et al. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29:2641–50.

    Article  PubMed  Google Scholar 

  12. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–32.

    Article  PubMed  Google Scholar 

  13. Voulgari C, Tentolouris N, Dilaveris P, Tousoulis D, Katsilambros N, Stefanadis C. Increased heart failure risk in normal-weight people with metabolic syndrome compared with metabolically healthy obese individuals. J Am Coll Cardiol. 2011;58:1343–50.

    Article  CAS  PubMed  Google Scholar 

  14. Li X, Li S, Ulusoy E, Chen W, Srinivasan SR, Berenson GS. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa heart study. Circulation. 2004;110:3488–92.

    Article  PubMed  Google Scholar 

  15. van Putte-Katier N, Rooman RP, Haas L, Verhulst SL, Desager KN, Ramet J, et al. Early cardiac abnormalities in obese children: importance of obesity per se versus associated cardiovascular risk factors. Pediatr Res. 2008;64:205–9.

    Article  PubMed  Google Scholar 

  16. Mehta S, Holliday C, Hayduk L, Wiersma L, Ricahrds N, Younoszai A. Comparison of myocardial function in children with body mass indexes ≥ 25 versus those < 25 kg/m2. Am J Cardiol. 2004;93:1567–9.

    Article  PubMed  Google Scholar 

  17. Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, et al. Impact of obesity on cardiac geometry and function in a population of adolescents. J Am Coll Cardiol. 2006;47:2267–73.

    Article  PubMed  Google Scholar 

  18. Saltijeral A, de Isla LP, Pérez-Rodríguez O, Rueda S, Fernandez-Golfin C, Almeria C, et al. Early myocardial deformation changes associated to isolated obesity: a study based on 3D-wall motion tracking analysis. Obesity. 2011;19:2268–73.

    Article  PubMed  Google Scholar 

  19. Cozzolino D, Grandone A, Cittadini A, Palmiero G, Esposito G, De Bellis A, et al. Subclinical myocardial dysfunction and cardiac autonomic dysregulation are closely associated in obese children and adolescents: the potential role of insulin resistance. PLoS One. 2015;10:e0123916.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51:1342–8.

    Article  PubMed  Google Scholar 

  21. Michalsky MP, Raman SV, Teich S, Schuster DP, Bauer JA. Cardiovascular recovery following bariatric surgery in extremely obese adolescents: preliminary results using cardiac magnetic resonance (CMR) imaging. J Pediatr Surg. 2013;48:170–7.

    Article  PubMed  Google Scholar 

  22. Barbosa MM, Beleigoli AM, de Fatima DM, Freire CV, Ribeiro AL, Nunes MCP. Strain imaging in morbid obesity: insights into subclinical ventricular dysfunction. Clin Cardiol. 2011;34:288–93.

    Article  PubMed  Google Scholar 

  23. Orhan AL, Uslu N, Dayi SU, Nurkalem Z, Uzun F, Erer HB, et al. Effects of isolated obesity on left and right ventricular function: a tissue Doppler and strain rate imaging study. Echocardiography. 2010;27:236–43.

    Article  PubMed  Google Scholar 

  24. Bays HE. Adiposopathy. J Am Coll Cardiol. 2011;57:2461–73.

    Article  CAS  PubMed  Google Scholar 

  25. Mattu HS, Randeva HS. Role of adipokines in cardiovascular disease. J Endocrinol. 2013;216:T17–36.

    Article  CAS  PubMed  Google Scholar 

  26. Blüher M. Adipokines—removing road blocks to obesity and diabetes therapy. Mol Metab. 2014;3:230–40.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ukkola O, Santaniemi M. Adiponectin: a link between excess adiposity and associated comorbidities? J Mol Med. 2002;80:696–702.

    Article  CAS  PubMed  Google Scholar 

  28. Han SH, Quon MJ, Kim J-A, Koh KK. Adiponectin and cardiovascular disease: response to therapeutic interventions. J Am Coll Cardiol. 2007;49:531–8.

    Article  CAS  PubMed  Google Scholar 

  29. Van Berendoncks AM, Garnier A, Beckers P, Hoymans VY, Possemiers N, Fortin D, et al. Functional adiponectin resistance at the level of the skeletal muscle in mild to moderate chronic heart failure. Circ Heart Fail. 2010;3:185–94.

    Article  PubMed  Google Scholar 

  30. Baker AR, Silva NFD, Quinn DW, Harte AL, Pagano D, Bonser RS, et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol. 2006;5:1.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Perego L, Pizzocri P, Corradi D, Maisano F, Paganelli M, Fiorina P, et al. Circulating leptin correlates with left ventricular mass in morbid (grade III) obesity before and after weight loss induced by bariatric surgery: a potential role for leptin in mediating human left ventricular hypertrophy. J Clin Endocrinol Metab. 2005;90:4087–93.

    Article  CAS  PubMed  Google Scholar 

  32. Konstantinides S, Schafer K, Loskutoff DJ. The prothrombotic effects of leptin possible implications for the risk of cardiovascular disease in obesity. Ann N Y Acad Sci. 2001;947:134–41. discussion 141–2

    Article  CAS  PubMed  Google Scholar 

  33. Tretjakovs P, Jurka A, Bormane I, Mackevics V, Mikelsone I, Balode L, et al. Relation of inflammatory chemokines to insulin resistance and hypoadiponectinemia in coronary artery disease patients. Eur J Intern Med. 2009;20:712–7.

    Article  CAS  PubMed  Google Scholar 

  34. Schulze PC, Kratzsch J, Linke A, Schoene N, Adams V, Gielen S, et al. Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure. Eur J Heart Fail. 2003;5:33–40.

    Article  PubMed  Google Scholar 

  35. Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008;52:1201–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Obesity and risk of incident heart failure in older men with and without pre-existing coronary heart disease: does leptin have a role? J Am Coll Cardiol. 2011;58:1870–7.

    Article  CAS  PubMed  Google Scholar 

  37. Smith CCT, Dixon RA, Wynne AM, Theodorou L, Ong S-G, Subrayan S, et al. Leptin-induced cardioprotection involves JAK/STAT signaling that may be linked to the mitochondrial permeability transition pore. AJP: Heart Circ Physiol. 2010;299:H1265–70.

    CAS  Google Scholar 

  38. Nagaya N, Uematsu M, Kojima M, Ikeda Y, Yoshihara F, Shimizu W, et al. Chronic administration of ghrelin improves left ventricular dysfunction and attenuates development of cardiac cachexia in rats with heart failure. Circulation. 2001;104:1430–5.

    Article  CAS  PubMed  Google Scholar 

  39. Nagaya N, Moriya J, Yasumura Y, Uematsu M, Ono F, Shimizu W, et al. Effects of ghrelin administration on left ventricular function, exercise capacity, and muscle wasting in patients with chronic heart failure. Circulation. 2004;110:3674–9.

    Article  CAS  PubMed  Google Scholar 

  40. 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;109:962–5.

    Article  CAS  PubMed  Google Scholar 

  41. 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. J Card Fail. 2006;12:694–9.

    Article  CAS  PubMed  Google Scholar 

  42. Nathanson D, Ullman B, Löfström U, Hedman A, Frick M, Sjöholm A, et al. Effects of intravenous exenatide in type 2 diabetic patients with congestive heart failure: a double-blind, randomised controlled clinical trial of efficacy and safety. Diabetologia. 2012;55:926–35.

    Article  CAS  PubMed  Google Scholar 

  43. Margulies KB, Hernandez AF, Redfield MM, Givertz MM, Oliveira GH, Cole R, et al. For the NHLBI heart failure clinical research network. Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction. JAMA. 2016;316:500–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Vest AR, Heneghan HM, Schauer PR, Young JB. Surgical management of obesity and the relationship to cardiovascular disease. Circulation. 2013;127:945–59.

    Article  PubMed  Google Scholar 

  45. Esteban Varela J, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11:987–90.

    Article  PubMed  Google Scholar 

  46. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel 1991. p. 956–961.

  47. Brito JP, Montori VM, Davis AM. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. JAMA. 2017;317:635–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, et al. On behalf of the American Heart Association obesity Committee of the Council on nutrition, physical activity, and metabolism. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123:1683–701.

    Article  PubMed  Google Scholar 

  49. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  50. • Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143–55. This 12-year observational study describes clinical outcomes for 1156 patients with severe obesity who either underwent RYGB, sought but did not undergo surgery or did not seek surgery. It shows long-term durability of surgical weight loss and sustained remission of type 2 diabetes, hypertension and hyperlipidemia, with 51% of patients with pre-operative diabetes have sustained diabetes remission at 12 years.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98:1763–77.

    Article  PubMed  Google Scholar 

  52. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1577–85.

    Article  Google Scholar 

  53. • Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51. The most recent STAMPEDE report describes the outcomes at 5 years after randomization to optimal medical therapy vs RYGB vs laparoscopic sleeve gastrectomy for type 2 diabetes control. The surgical groups achieved the greatest remission from diabetes as well as the more favorable weight loss and quality of life profiles.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Carlsson LMS, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695–704.

    Article  CAS  PubMed  Google Scholar 

  55. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.

    Article  Google Scholar 

  56. Chang S-H, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery. JAMA Surg. 2014;149:275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  57. •• Vest AR, Patel P, Schauer PR, Satava ME, Cavalcante JL, Brethauer S, et al. Clinical and echocardiographic outcomes after bariatric surgery in obese patients with left ventricular systolic dysfunction. Circ Heart Fail. 2016;9:e002260. This retrospective cohort study was the first to report the weight loss efficacy and surgical safety of bariatric procedures in patients with left ventricular systolic dysfunction as compared to the general bariatric population. An echocardiographic subgroup showed a modest improvement in left ventricular ejection fraction in patients with systolic dysfunction who underwent bariatric surgery, with ejection fraction improvement more likely in patients without a baseline history of myocardial infarction.

    Article  PubMed  Google Scholar 

  58. Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002–7. discussion 1007–9

    Article  PubMed  Google Scholar 

  59. Ma IT, Madura JA. Gastrointestinal complications after bariatric surgery. Gastroenterol Hepatol. 2015;11:526–35.

    Google Scholar 

  60. Triantafyllidis G, Lazoura O, Sioka E, Tzovaras G, Antoniou A, Vassiou K, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2010;21:473–8.

    Article  Google Scholar 

  61. Zhang Y, Wang J, Ju W, Sun X, Cao Z, Cao Z, et al. Laparoscopic sleeve gastrectomy versus laparoscopic roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25:19–26.

    Article  PubMed  Google Scholar 

  62. Maxwell BG, Ingrande J, Rosenthal DN, Ramamoorthy C. Perioperative management of the morbidly obese adolescent with heart failure undergoing bariatric surgery. Pediatr Anesth. 2012;22:476–82.

    Article  Google Scholar 

  63. Kopp HP. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscl Throm Vas. 2003;23:1042–7.

    Article  CAS  Google Scholar 

  64. Luaces M, Cachofeiro V, García-Muñoz-Najar A, Medina M, González N, Cancer E, et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012;65:14–21.

    Article  PubMed  Google Scholar 

  65. Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbély Y, Beglinger C. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy—a prospective randomized trial. Surg Obes Relat Dis. 2011;7:561–8.

    Article  PubMed  Google Scholar 

  66. Leichman JG, Aguilar D, King TM, Mehta S, Majka C, Scarborough T, et al. Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery. Surg Obes Relat Dis. 2006;2:592–9.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Rider OJ, Francis JM, Ali MK, Petersen SE, Robinson M, Robson MD, et al. Beneficial cardiovascular effects of bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54:718–26.

    Article  PubMed  Google Scholar 

  68. Ikonomidis I, Mazarakis A, Papadopoulos C, Patsouras N, Kalfarentzos F, Lekakis J, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25:439–47.

    Article  CAS  PubMed  Google Scholar 

  69. Willens HJ, Chakko SC, Byers P, Chirinos JA, Labrador E, Castrillon JC, et al. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. Am J Cardiol. 2005;95:1521–4.

    Article  PubMed  Google Scholar 

  70. 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. Am J Cardiol. 2010;105:550–6.

    Article  PubMed  Google Scholar 

  71. Shah RV, Murthy VL, Abbasi SA, Eng J, Wu C, Ouyang P, et al. Weight loss and progressive left ventricular remodelling: the multi-ethnic study of atherosclerosis (MESA). Eur J Prev Cardiol. 2014;22:1408–18.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Leichman J, Wilson E, Scarborough T, Aguilar D, Miller C, Yu S, et al. Dramatic reversal of derangements in muscle metabolism and left ventricular function after bariatric surgery. Am J Med. 2008;121:966–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Kanoupakis E, Michaloudis D, Fraidakis O, Parthenakis F, Vardas P, Melissas J. Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg. 2001;11:552–8.

    Article  CAS  PubMed  Google Scholar 

  74. Di Bello V, Santini F, Di Cori A, Pucci A, Talini E, Palagi C, et al. Effects of bariatric surgery on early myocardial alterations in adult severely obese subjects. Cardiology. 2008;109:241–8.

    Article  PubMed  Google Scholar 

  75. Koshino Y, Villarraga HR, Somers VK, Miranda WR, Garza CA, Hsiao J-F, et al. Changes in myocardial mechanics in patients with obesity following major weight loss after bariatric surgery. Obesity. 2013;21:1111–8.

    Article  PubMed  Google Scholar 

  76. • Kaier TE, Morgan D, Grapsa J, Demir OM, Paschou SA, Sundar S, et al. Ventricular remodelling post-bariatric surgery: is the type of surgery relevant? A prospective study with 3D speckle tracking. Eur Heart J Cardiovasc Imaging. 2014;15:1256–62. A single-center study of obese patients without HF, highlighting the regression of biventricular hypertrophy and abnormal global longitudinal strain that follows successful surgical weight loss .

    Article  PubMed  Google Scholar 

  77. •• Benotti PN, Wood GC, Carey DJ, Mehra VC, Mirshahi T, Lent MR, et al. Gastric bypass surgery produces a durable reduction in cardiovascular disease risk factors and reduces the long-term risks of congestive heart failure. J Am Heart Assoc. 2017;6:e005126. A cohort of RYGB patients was compared to a matched cohort of non-surgical obese patients, with follow-up for up to 12 years ( n = 1724 per cohort). There was a significantly lower rate of the composite cardiovascular endpoint in surgical group, as well as a lower rate of incident HF.

    Article  PubMed  PubMed Central  Google Scholar 

  78. •• Persson CE, Björck L, Lagergren J, Lappas G, Giang KW, Rosengren A. Risk of heart failure in obese patients with and without bariatric surgery in Sweden—a registry-based study. J Card Fail. 2017;23:530–7. A cohort of 22,295 obese patients who underwent bariatric surgery (mostly RYGB) was compared to 25,564 obese patients who were managed non-surgically in Sweden. Even after covariate adjustment, the hazard of HF development was significantly lower in the surgical group than the non-surgical group.

    Article  PubMed  Google Scholar 

  79. •• Sundström J, Bruze G, Ottosson J, Marcus C, Näslund I, Neovius M. Weight loss and heart failure: a nationwide study of gastric bypass surgery versus intensive lifestyle treatment. Circulation. 2017;135:1577–85. Patients who received bariatric surgery in the Scandinavian Obesity Surgery Registry ( n = 25,804) were compared to a nationwide registry of patients receiving a structured intensive lifestyle program ( n = 13,701) for obesity management. Over a median 4-year follow-up, surgical patients had a significantly lower hazard of HF development than the lifestyle modification patients.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Jamaly S, Carlsson L, Peltonen M, Jacobson P, Sjöström L, Karason K. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. J Am Coll Cardiol. 2016;68:2497–504.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Look AHEAD research group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes Relat Metab Disord. 2005;29:1153–67.

    Article  CAS  Google Scholar 

  83. 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. J Obes Weight Loss Ther. 2012;2:1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Evangelista LS, Heber D, Li Z, Bowerman S, Hamilton MA, Fonarow GC. Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure: a feasibility study. J Cardiovasc Nurs. 2009;24:207–15.

    Article  PubMed  PubMed Central  Google Scholar 

  85. O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1439–50.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, et al. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1451–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Horwich TB, Broderick S, Chen L, McCullough PA, Strzelczyk T, Kitzman DW, et al. Relation among body mass index, exercise training, and outcomes in chronic systolic heart failure. Am J Cardiol. 2011;108:1754–9.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142:532–46.

    Article  CAS  PubMed  Google Scholar 

  89. Beck-da-Silva L, Higginson L, Fraser M, Williams K, Haddad H. Effect of Orlistat in obese patients with heart failure: a pilot study. Congest Heart Fail. 2005;11:118–23.

    Article  CAS  PubMed  Google Scholar 

  90. Zuber M, Kaeslin T, Studer T, Erne P. Weight loss of 146 kg with diet and reversal of severe congestive heart failure in a young, morbidly obese patient. Am J Cardiol. 1999;84:955–6.

    Article  CAS  PubMed  Google Scholar 

  91. Iyengar S, Leier C. Rescue bariatric surgery for obesity-induced cardiomyopathy. Am J Med. 2006;119:e5–e6.

    Article  Google Scholar 

  92. Ristow B, Rabkin J, Haeusslein E. Improvement in dilated cardiomyopathy after bariatric surgery. J Card Fail. 2008;14:198–202.

    Article  PubMed  Google Scholar 

  93. Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol. 1985;55:783–6.

    Article  CAS  PubMed  Google Scholar 

  94. Alpert MA, Terry BE, Mulekar M, Cohen MV, Massey CV, Fan TM. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol. 1997;80:736–40.

    Article  CAS  PubMed  Google Scholar 

  95. McCloskey CA, Ramani GV, Mathier MA, Schauer PR, Eid GM, Mattar SG, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007;3:503–7.

    Article  CAS  PubMed  Google Scholar 

  96. Ramani GV, McCloskey C, Ramanathan RC, Mathier MA. Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure. Clin Cardiol. 2008;31:516–20.

    Article  PubMed  Google Scholar 

  97. •• Shimada YJ, Tsugawa Y, Brown DFM, Hasegawa K. Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series. J Am Coll Cardiol. 2015;67:895–903. This was the first analysis of HF hospitalizations/emergency room visits for patients with obesity before and after bariatric surgery, using data from 3 US states. Amongst 524 patients, 16.2% had a HF hospitalization/emergency room visit in the time period 13–24 months prior to bariatric surgery. There was a non-significant reduction in HF visits in the first 12 months after bariatric surgery and a significantly reduction in months 13–24 after bariatric surgery (to 9.9%).

    Article  Google Scholar 

  98. Chaudhry UI, Kanji A, Sai-Sudhakar CB, Higgins RS, Needleman BJ. Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results. Surg Obes Relat Dis. 2015;11:88–93.

    Article  PubMed  Google Scholar 

  99. Greene J, Tran T, Shope T. Sleeve gastrectomy and left ventricular assist device for heart transplant. JSLS. 2017;21:e 2017.00049.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA

    Amanda R. Vest

Authors
  1. Amanda R. Vest
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amanda R. Vest.

Ethics declarations

Conflict of Interest

The author declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Management of Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vest, A.R. Has the Time Come to Be More Aggressive With Bariatric Surgery in Obese Patients With Chronic Systolic Heart Failure?. Curr Heart Fail Rep 15, 171–180 (2018). https://doi.org/10.1007/s11897-018-0390-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-018-0390-z

Keywords

Search

Navigation