Effects of laparoscopic sleeve gastrectomy on cardiac structure and function in obese patients with different types of heart failure

JIA Xiao-yan; LIAN Rui-jia; HU Yang-xi; ZHOU Li; MA Bao-dong; MA Xi-wen

doi:10.13820/j.cnki.gdyx.20251440

Abstract：Objective To evaluate the differential effects of Laparoscopic Sleeve Gastrectomy(LSG)on cardiac structure and function in obese patients with Heart Failure with preserved Ejection Fraction(HFpEF),Heart Failure with mildly reduced Ejection Fraction(HFmrEF),and Heart Failure with reduced Ejection Fraction(HFrEF).Methods A prospective cohort study was conducted,enrolling 26 obese patients with HF who underwent LSG between January and De-cember 2024.According to preoperative left ventricular ejection fraction(LVEF),they were classified into HFpEF(n=12),HFmrEF(n=6),and HFrEF(n=8)groups.Changes in body mass index(BMI),body surface area(BSA),and echocardiographic parameters from baseline to the last follow-up(median follow-up:7.0 months)were compared,and the degree of change(Δ)between groups was analyzed.Results Among the 26 enrolled patients,73.1％were male,with a mean age of(32.8±8.5)years,mean BMI of(57.1±12.7)kg/m2,and mean BSA of(2.83±0.36)m2.All groups showed significant reductions in weight,BMI,and BSA after surgery(P＜0.05).At the last follow-up,the HFpEF group showed significant reductions in left atrial volume index(LADi),left ventricular end-diastolic internal diameter(LVIDd),interventricular septal thickness(IVSTd),left ventricular posterior wall thickness(PWTd),left ventricular end-diastolic volume(LVEDV),right atrial short-axis diameter(RAD2),and right ventricular diameter(RVD);the HFmrEF group showed a significant reduction in left ventricular end-systolic volume(LVESV);and the HFrEF group showed significant reductions in left atrial diameter(LAD),LVIDd,LVESV,and right atrial long-axis di-ameter(RAD1).LVEF and left ventricular fractional shortening(LVFS)significantly increased in the HFmrEF and HFrEF groups,while pulmonary artery systolic pressure(PASP),tricuspid regurgitation velocity(TRv),and cardiac output(CO)significantly decreased.Intergroup comparison showed that the reductions in LVIDd,LVEDV,LVESV,and LVEDVi were significantly greater in the HFrEF group than in the HFpEF group(P＜0.05).Conclusion LSG can rap-idly and effectively reduce weight,BMI,and BSA in obese patients with different types of HF,and significantly improve their cardiac structure and function in the short term.LSG produces the most pronounced reverse remodeling of both atrial and ventricular structures and improves left ventricular systolic function in obese patients with HFrEF,while in HFpEF pa-tients,it mainly reduces left ventricular hypertrophy and improves right heart structure.LSG may provide a potential thera-peutic option with cardiac benefits for obese patients with HF,especially those with HFrEF.