The effect of weight loss surgery on cardiovascular haemodynamics in adults with obesity

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Obesity continues to be a major public health concern in Australia and overseas. In particular, obesity contributes to changes in the heart’s blood flow in the form of increased circulating blood volume, cardiac output, systolic blood pressure and pulmonary pressures. Long-term, these lead to the development of heart failure, atrial fibrillation and ischaemia. Furthermore, fat deposited around the heart is associated with the development of a specific type of heart failure common in individuals with obesity. Hence, obesity is considered an important risk factor for cardiovascular disease. However, there is growing evidence that effective management of obesity also improves cardiovascular outcomes for patients. Bariatric surgery, an established treatment for weight loss, has been shown to reduce the incidence of cardiovascular risk factors and heart attacks. In this study, we seek to assess the impact of bariatric surgery on the heart’s structures and blood flow using cardiac magnetic resonance imaging (CMR). Although ultrasound technology or echocardiography is widely used for assessing such features, challenges remain when acquiring accurate images in those with obesity. CMR offers an opportunity to overcome some of these imaging challenges. CMR is less user dependent compared to echocardiography and has demonstrated excellent feasibility in this population. We hypothesize that bariatric surgery will lead to a decrease in cardiac output, and reductions in the degree of fibrosis of the heart muscle and the volume of fat around the heart as measured by pre- and post-surgery CMR, thus reducing cardiovascular disease risk. Eighty participants will be recruited for this study. Assessments will include cardiac imaging scans, measurement of exercise capacity, blood tests, and quality of life questionnaires. These will be performed before and 12 months after their bariatric surgery.

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