Improvements in systemic metabolism, anthropometrics, and left
ventricular geometry 3 months after bariatric surgery
Joshua G. Leichman, M.D.,
David Aguilar, M.D.,
Terri M. King, Ph.D.,
Snehal Mehta, M.D.,
Charles Majka, B.S.,
Terry Scarborough, M.D.,
Erik B. Wilson, M.D.,
Heinrich Taegtmeyer, M.D., D.Phil.
Division of Cardiology, University of Texas Houston Medical School, Houston, Texas
Division of Cardiology, Baylor College of Medicine, Houston, Texas
Department of Pediatrics, University of Texas Houston Medical School, Houston, Texas
River Oaks Imaging and Diagnostics, Houston, Texas
Department of Surgery, University of Texas Houston Medical School, Houston, Texas
Received May 9, 2006; revised August 24, 2006; accepted September 12, 2006
Abstract Background: Several lines of evidence have suggested a link between obesity and heart failure,
including chronic inﬂammation, increased sympathetic tone, and insulin resistance. The goal of this
study was to evaluate the changes in systemic metabolism, anthropometrics, and left ventricular
(LV) contraction, as well as geometry, in clinically severe obese women after bariatric surgery.
Methods: Enrollment was offered consecutively to 22 women with clinically severe obesity.
Participants underwent abdominal magnetic resonance imaging to quantify the visceral adipose
tissue (VAT) area and tissue Doppler imaging echocardiography to measure the LV contractile
function. Fasting blood chemistries were drawn to measure inﬂammatory markers and to calculate
insulin sensitivity. All tests were performed before surgery and 3 months postoperatively.
Results: Three months after surgery, a signiﬁcant increase in insulin sensitivity (mean change Ϯ SEM
34.0 Ϯ 10.4, P Ͻ.0001) was present. The VAT area had signiﬁcantly decreased (Ϫ66.1 Ϯ 17.8 cm
ϭ .002) and was associated with decreases in body mass index, serum glucose concentrations, and
high-sensitivity C-reactive protein levels (r ϭ .61 and P ϭ .005, r ϭ .48 and P ϭ .033, and r ϭ .53 and
P ϭ .016, respectively). The LV mass decreased signiﬁcantly (Ϫ3.8 Ϯ 1.7 g/m
, P ϭ .037), and this
decrease was associated with a decrease in glucose concentration (r ϭ .46, P ϭ .041). The LV systolic
and diastolic contractile function were normal at baseline, and no change occurred after surgery.
Conclusion: The early phase of weight loss after bariatric surgery produces favorable changes in
LV geometry, and these are associated with normalization in the glucose metabolism. © 2006
American Society for Bariatric Surgery. All rights reserved.
Keywords: Obesity; Magnetic resonance imaging; Left ventricular hypertrophy; Echocardiograph; Insulin resistance
Obesity is an independent risk factor for the development of
heart failure in men and women . Subclinical heart failure
has been demonstrated in young women with obesity .
However, the mechanisms for the development of heart
failure in obesity have not been fully elucidated. Several
lines of evidence, in both human and animal models, have
suggested that changes in glucose and lipid metabolism
have an untoward effect on left ventricular (LV) contractile
Supported in part from the National Institutes of Health, National Heart,
Lung, and Blood Institute (5RO1 HL073162-02) to H. Taegtmeyer; American
Society of Bariatric Surgeons Research grant to E. B. Wilson; and University
of Texas Houston General Clinical Research Center (grant M01RR002558)
*Reprint requests: Heinrich Taegtmeyer, M.D., D.Phil., Division of
Cardiology, University of Texas Houston Medical School, 6431 Fannin,
MSB 1.220, Houston, TX 77030.
Surgery for Obesity and Related Diseases 2 (2006) 592–599
1550-7289/06/$ – see front matter © 2006 American Society for Bariatric Surgery. All rights reserved.