Although studies with short-term follow-up have shown that weight loss (WL) has positive benefits on the heart, there was limited data on the long-term or long-term consequences of visceral fat reduction. For a study, researchers sought to assess the effects of long-term WL following bariatric surgery on heart structure, function, ventricular interaction, and body composition, particularly epicardial adipose thickness and abdominal visceral adipose tissue (VAT).

A total of 213 obese individuals in all had echocardiograms performed before and >180 days after having weight-loss surgery. About 52 of these individuals had abdominal VAT area measurements using computed tomography.

Body mass index (BMI) dropped by 22% after 5.3 years (IQR: 2.9-7.9 years), and the entire cohort saw beneficial reductions in blood pressure, fasting glucose, and left ventricular (LV) remodeling. The VAT area fell by 30% in the sample of patients who had abdominal computed tomography. Epicardial adipose thickness was decreased in all patients by 14% (both P<0.0001) along with decreased ventricular interdependence. Following WL, the left atrial (LA) and right ventricular (RV) longitudinal strains both decreased, but the LA strain worsened while the LA volume and estimated LA pressures rose. In subgroup analysis, reductions in LV mass after surgery were connected with reductions in VAT but not BMI, and LV wall thickness and strain were more strongly correlated with baseline VAT than baseline BMI.

In the observational research, weight loss after bariatric surgery was linked to decreased epicardial fat, lessened ventricular interaction, LV reverse remodeling, and better longitudinal biventricular mechanics, while LA myopathy and hemodynamic congestion continued to worsen. Visceral fat reduction was linked to positive cardiac outcomes, which suggested that it may be a major focus of WL therapies.

Reference: jacc.org/doi/10.1016/j.jacc.2022.08.738