Successful long-term weight reduction improves left ventricular diastolic function and physical performance in severe obesity

Background: Obesity is a risk factor for left ventricular diastolic function (LVDD), yet the impact of long-term weight reduction (LTWR) on diastolic function remains unclear. We assessed the effect of LTWR on diastolic function in morbidly obese subjects over 1 year. Methods: Eligible participants with a BMI ≥30kg/m2 and stable body weight over the preceding 3 months underwent a 1-year WR program. Echocardiography and exercise capacity (6-minute walk test) were performed at baseline and at 1 year. Subjects were dichotomized according to weight reduction above 8% after 1 year. Results: From a total of 127 subjects completing follow-up, 66 achieved LTWR and 61 did not. Baseline clinical and echocardiographic parameters were broadly similar in both groups. At follow-up, LTWR was associated with improvement in all parameters of body composition, decrease in both systolic and diastolic blood pressure as well as marked reduction of fasting glucose, insulin, HOMA-IR, and triglyceride levels. Those with LTWR demonstrated significant improvement in individual echocardiographic parameters of LVDD (including E/A, e, e'/a', Ard and Ard-Ad) and a greater likelihood of improvement in multiple parameters compared to those without LTWR. LTWR was also associated with significantly greater improvement in 6-minute walk distance. A multiple linear regression model identified fat index (estimated fat mass ÷ height2) as an independent factor influencing LVDD. Conclusions: In morbid obesity, LTWR was associated with improved LV diastolic function and improved exercise capacity. Moreover, reduction of fat index independently correlated with improved diastolic function following LTWR.