IJCS | Volume 32, Nº5, September/October 2019

528 Figure 1 - Selection of the publications analyzed. Mourilhe-Rocha and Salvino Obesity and heart failure Int J Cardiovasc Sci. 2019;32(5):527-535 Review Article There is little evidence of the long-term beneficial effect of intentional non-surgical little weight loss on the outcome of HF. However, observational studies have shown that bariatric surgery has a beneficial effect on ventricular structure and function in morbidly obese individuals 21 with HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). 22 Bariatric surgery is currently the major treatment available that leads to sustained weight loss and significant improvement or complete resolution of morbid obesity-related comorbidities. 2,21 Understanding the safety and feasibility of that procedure in patients at higher surgical risk is fundamental. Objective This review was aimed at describing the relationship between obesity andHF, as well as the safety and benefits of bariatric surgery in obese patients. Methods This study comprised the review of the literature in the PubMed database over the last 15 years. The following terms were used: “obesity and heart failure and bariatric”; and “bariatric surgery and cardiac alterations”. The search retrieved 139 publications, after excluding duplicates. After excluding the articles not related to the topic studied, 47 articles were selected for analysis (Figure 1). The European Guideline for the Treatment of Obesity in Adults was used to define and classify obesity. 23 According to that guideline, for adults aged > 18 years, overweight or preobesity is characterized by a BMI between 25 and 29.9 kg/m 2 , and obesity is characterized by a BMI ≥ 30 kg/m 2 , being subdivided into grade I (BMI = 30-34.9 kg/m 2 ), grade II (BMI = 35-39.9 kg/m 2 ), and grade III or morbid obesity (BMI ≥ 40 kg/m 2 ). 23 Heart failure was defined according to the European Guideline for the Diagnosis and Treatment of Acute and Chronic Heart Failure. 24 Heart failure is a clinical syndrome characterized by typical symptoms, such as dyspnea, lower limb edema and fatigue, which can be accompanied by signs, such as jugular venous distension and pulmonary rales caused by cardiac structural and/ or functional abnormality, resulting in reduced cardiac output and/or high intracardiac pressures at rest or during stress.