Efeitos da cirurgia bariátrica sobre a anatomia e a função do ventrículo esquerdo

Obesity is associated with changes in left ventricular (LV) structure and function. Bariatric surgery can favorably improve cardiac remodeling. The effects of the procedure in LV diastolic and systolic function have not been clearly defined. The aim of this study was to evaluate the changes in left ventricular structure, systolic and diastolic function in obese patients who have undergone bariatric surgery. We evaluated twenty-three patients (16 women, 7 men; 32,9 ± 8,9 years) with body mass index above 40 submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively and 3-7 months after the surgery. After a mean follow-up of 4,7 months, body weight was significantly reduced from 126,3 ± 25 to 97,7 ± 19 kg (p < 0,001) and body mass index from 46,7 ± 5,3 to 36,2 ± 4,7 kg/m2 (p< 0,001). Systolic blood pressure was reduced from 138,6 ± 14,9 to 118,8 ± 8,9 mmHg (p < 0,001) and diastolic blood pressure from 85,8 ± 10,4 to 79,7 ± 6,5 mmHg (p 0,002). Echocardiography showed decrease of the interventricular septum and left ventricular (LV) posterior wall thickness (10,3 ± 1,4 to 8,9 ± 1,2 mm and 9,3 ± 1,3 to 8,4 ± 1,1 mm, respectively; p < 0,001). After surgery, there was a reduction in left ventricular mass (LVM) (absolute value: 168,7 ± 35,2 to 149,8 ± 40,7 g, p 0,008; value indexed by height: 45,1 ± 11,3 to 39,7 ± 10,3, p 0,006) and in LV relative wall thickness (RWT) from 0,39 ± 0,06 to 0,34 ± 0,04 (p<0,001). The prevalence of normal left ventricular geometry improved from 60,9% before surgery to 91,3% at follow-up. Tissue Doppler imaging detected improvement in the LV diastolic function (mitral E’ lateral 0,16 ± 0,03 m/s preoperative vs. 0,17 ± 0,03 m/s at follow-up; p 0,026). There was no significant difference in LV systolic function measured by ejection fraction and fractional shortening. Bariatric surgery promotes improvement in left ventricular structure and diastolic function. There were no changes in left ventricular systolic parameters.