IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190001 527 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2019;32(5):527-535 Mailing Address: Ricardo Mourilhe-Rocha Rua Voluntários da Pátria, 445/1401. Postal Code: 22270-000, Botafogo, Rio de Janeiro, RJ - Brazil. E-mail: ricardomourilhe@gmail.com Impact of Obesity and Bariatric Surgery in the Outcome of Patients with Heart Failure Ricardo Mourilhe-Rocha 1, 2 a nd Nathália Felix Araujo Salvino 2, 3 Hospital Universitário Pedro Ernesto, 1 Rio de Janeiro, RJ - Brazil Hospital Pró-Cardíaco, 2 Rio de Janeiro, RJ - Brazil Associação Brasileira de Nutrologia - ABRAN, 3 Catanduva, São Paulo - Brazil Manuscript received December 21, 2017, revised manuscript May 13, 2018, accepted June 19, 2018. Hypertrophy, Left Ventricular; Heart Failure; Obesity; Bariatric Surgery; Comorbidity; Quality of Life. Keywords Abstract Currently, the association between obesity and heart failure (HF) is increasingly known. Patientswith advanced obesity who suffer from HF without an identifiable cause can be diagnosed as having obesity-associated cardiomyopathy. Although data suggest that obesity may reduce mortality in HF, weight loss, especially in the presence of morbid obesity, reduces symptoms and improves the quality of life of those patients. Bariatric surgery is the major treatment available for sustained weight loss in morbid obesity. Observational studies have demonstrated an improvement inventricular structure and function of morbidly obese patients with HF who underwent that procedure. Thus, despite the risks, bariatric surgery should be considered for patients with HF, because of its potential for reducing associated comorbidities and improving quality of life and functional capacity, in addition to making eligible for heart transplantation those excluded due to high body mass index. Introduction The prevalence of obesity has reached epidemic proportions globally and is associated with generalized alterations in the cardiovascular structure and function. 1 On the other hand, the prevalence of heart failure (HF) is approximately 1% to 2% of the adult population of developed countries, and HF is one of the major causes of hospitalization, morbidity and mortality among the elderly (≥ 65 years). 2 In Brazil, according to the BREATHE study, 3 coronary artery disease is the major cause of HF (30.3%), whose major causes of decompensation are poor medication adherence (30.0%), infections (23.0%) and inadequate control of water and sodium ingestion (9.0%). 3 Heart failure is currently known to be associated with obesity, 2,4-15 regardless of the presence of comorbidities, such as arterial hypertension (AH) and coronary artery disease. 16,17 The FraminghamHeart Study reports that to every 1-kg/m 2 increase in bodymass index (BMI), the risk of developing HF increases by 5.0% in men and by 7.0% in women. 8 In addition to BMI, waist circumference and waist-hip ratio have been shown to be associated with HF in several cross-sectional and prospective studies. 12 Obese individuals have a two-fold increased risk of premature death as compared to non-obese individuals, in addition to a five-fold increased risk of death from cardiovascular disease. 18 That risk factor is also related to the higher incidence of atrial and ventricular arrhythmias 15 and sudden death. 5 Furthermore, obesity has frequent associations, such as systemic AH, diabetes mellitus (DM), dyslipidemias and sleep obstructive apnea, increasing even more the likelihood of cardiac impairment. 19 Left ventricular hypertrophy (LVH) is the major cardiacmorphological change related to obesity, 10,20 while diastolic dysfunction is the major functional change, manifested as elevated left ventricular (LV) end-diastolic pressure. 10 Obesity produces a variety of hemodynamic changes that can predispose to left and right ventricular dysfunction, even in the absence of cardiac comorbidities, a condition known as obesity cardiomyopathy. 20 Most obese patients withHF have preserved ejection fraction. 20 Thus, in the presence of LV systolic dysfunction, other associated etiologies should be sought.