Structural and Functional Cardiac Reverse Remodeling After Bariatric Surgery: A Prospective Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass-Uncorrected Proof

Objective: Obesity is associated with characteristic cardiac remodeling, including left ventricular
(LV) hypertrophy, concentric geometry, and subclinical myocardial dysfunction. Bariatric surgery induces reverse cardiac remodeling; however, it remains unclear whether structural and functional recovery differ between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), and to what extent these changes are driven by weight loss versus metabolic and inflammatory mechanisms.

Method: In this prospective observational cohort study, 100 adults with severe obesity (body mass index [BMI] > 35 kg/m²) undergoing primary bariatric surgery (SG, n = 50; RYGB, n = 50) were evaluated at baseline and six months postoperatively. Clinical, metabolic, inflammatory, and echocardiographic parameters—including left ventricular mass index (LVMI), epicardial adipose tissue (EAT) thickness, diastolic function, and global longitudinal strain (GLS)—were assessed using standardized transthoracic echocardiography with speckle-tracking analysis. Multivariable regression identified independent predictors of structural (ΔLVMI) and functional (ΔGLS) improvement.

Results: Baseline characteristics were comparable between groups (mean age 35.9 years; 67% female; BMI 47.1 kg/m²). Both procedures resulted in significant improvements in anthropometric, metabolic, inflammatory, and cardiac parameters. RYGB was associated with greater reductions in BMI (−10.74 ± 2.42 vs. −9.32 ± 2.42 kg/m²; P = 0.004), glycated hemoglobin (HbA1c) (median −1.40% vs. −0.90%; P = 0.007), and C-reactive protein (CRP) (P = 0.029). Structural reverse remodeling was more pronounced following RYGB, with greater reductions in LVMI (median −12.0 vs. −6.5 g/m²·⁷; P < 0.001) and EAT thickness (−1.20 vs. −0.70 mm; P = 0.014). GLS improved in both groups (−2.33% vs. −1.40%; P = 0.031). However, multivariable analysis demonstrated that improvement in GLS was independently associated with baseline GLS, reduction in LV mass, and improvements in HbA1c and CRP, rather than the type of surgical procedure.

Conclusion: Bariatric surgery leads to significant reverse cardiac remodeling in patients with severe obesity. RYGB is associated with greater structural regression, whereas improvement in myocardial deformation appears to be primarily driven by metabolic improvement and inflammatory changes rather than surgical technique. These findings suggest that cardiac recovery reflects an integrated process involving structural, metabolic, and inflammatory restoration beyond weight loss alone.

Keywords: Bariatric surgery, epicardial adipose tissue, global longitudinal strain, left ventricular remodeling, obesity