Parallel improvement of systolic function with surgical weight loss in patients with heart failure and reduced ejection fraction: a systematic review and patient-level meta-analysis

Abstract

Background: Morbid obesity (MO) is an increasingly common condition in patients with heart failure with reduced ejection fraction (HFrEF). Although substantial weight loss in morbidly obese patients has proved to slow the progression of heart failure, parallel alteration of ejection fraction (EF) and New York Heart Association (NYHA) functional class along with post-bariatric surgery weight loss is yet to be determined. Objectives: This systematic review aimed to measure the effect of bariatric weight loss on EF and NYHA functional class in patients with HFrEF. Methods: A systematic literature review was performed in Medline/PubMed to identify studies in patients with MO and pre-existing HFrEF, who underwent bariatric surgery. Results: A total of 11 studies encompassing 136 patients with HFrEF undergoing bariatric surgery for MO were included. Six studies provided patient-level data on 37 cases. Patients lost an average body mass index (BMI) of 12.9 +/- 4.2 kg/m(2) (5.1 to 23 kg/m(2)) after an average follow up of 22.43 +/- 18.6 months (2-89 mo). There was a direct correlation between BMI loss and EF improvement (r = 0.61, P <.0001), but not between BMI loss and NYHA functional class changes (r = 0.17, P = .4). Conclusion: Weight loss induced by bariatric surgery results in parallel EF increase in patients with MOand HFrEF. However, current data does not indicate a parallel improvement of clinical symptoms (NYHA functional class) along with such an increase in EF in this population of patients. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.