Normalization of Cardiac Function After Bariatric Surgery Is Related to Autonomic Function and Vitamin D

Sanne M. Snelder, Yaar Aga, Lotte E. de Groot - de Laat, L. Ulas Biter, Manuel Castro Cabezas, Nadine Pouw, Erwin Birnie, Bianca Boxma - de Klerk, René A. Klaassen, Felix Zijlstra, Bas M. van Dalen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Purpose: Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery. Methods: Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35–65 years and BMI ≥ 35 kg/m2. Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I. Results: A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery. Conclusion: Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)47-56
Number of pages10
JournalObesity Surgery
Issue number1
Early online date5 Nov 2022
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
This work was supported by a grant from Stichting BeterKeten.

Publisher Copyright:
© 2022, The Author(s).


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