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J Am Coll Cardiol, 2008; 51:1342-1348, doi:10.1016/j.jacc.2007.12.029 © 2008 by the American College of Cardiology Foundation |



* Division of Cardiology, Cincinnati Childrens Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Division of Pediatric General and Thoracic Surgery, Cincinnati Childrens Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Department of Pediatrics, The Childrens Hospital, Denver, Colorado.
Manuscript received May 24, 2007; revised manuscript received December 17, 2007, accepted December 18, 2007.
* Reprint requests and correspondence: Dr. Holly M. Ippisch, Cincinnati Childrens Hospital Medical Center, Division of Pediatric Cardiology, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229. (Email: Holly.Ippisch{at}cchmc.org).
Objectives: The purpose of this study was to evaluate changes in cardiac geometry, systolic and diastolic function before and after weight loss in morbidly obese adolescents.
Background: Cardiac abnormalities are present in morbidly obese adolescents; however, it is unclear if they are reversible with weight loss.
Methods: Data from 38 adolescents (13 to 19 years; 29 females, 9 males, 33 Caucasians, 5 African Americans) were evaluated before and after bariatric surgery. Left ventricular mass (LVM), left ventricular (LV) geometry, systolic and diastolic function were assessed by echocardiography. Mean follow up was 10 ± 3 months.
Results: Weight and body mass index decreased post-operatively (mean weight loss 59 ± 15 kg, pre-operative body mass index 60 ± 9 kg/m2 vs. follow-up 40 ± 8 kg/m2, p < 0.0001). Change in LVM index (54 ± 13 g/m2.7 to 42 ± 10 g/m2.7, p < 0.0001) correlated with weight loss (r = 0.41, p = 0.01). Prevalence of concentric left ventricular hypertrophy (LVH) improved from 28% at pre-operative to only 3% at follow up (p = 0.007), and normal LV geometry improved from 36% to 79% at follow up (p = 0.009). Diastolic function also improved (mitral E/Ea lateral 7.7 ± 2.3 at pre-operative vs. 6.3 ± 1.6 at post-operative, p = 0.003). In addition, rate-pressure product improved suggesting decreased cardiac workload (p < 0.001).
Conclusions: Elevated LVM index, concentric LVH, altered diastolic function, and cardiac workload significantly improve following surgically induced weight loss in morbidly obese adolescents. Large weight loss due to bariatric surgery improves predictors of future cardiovascular morbidity in these young people.
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