AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Cardiometabolic Determinants of Cardiac Remodeling and Functional Recovery Following Bariatric Surgery: Insights from MRI-Derived Fat Distribution
By Hung CH, Lin JW, Chen JH et al.
Background: Obesity is associated with adverse cardiac remodeling. Although bariatric surgery improves cardiac structure and function, the relative contributions of regional fat distribution, blood pressure (BP), and insulin resistance to cardiac recovery remain incompletely understood. We investigated the cardiometabolic determinants of obesity-related cardiac remodeling and predictors of cardiac recovery following bariatric surgery. Methods: Forty adults with severe obesity (BMI ≥35 kg/m ² ; age 40±10 years; 22 men) undergoing bariatric surgery were prospectively enrolled. Participants underwent clinical assessment, laboratory testing, echocardiography, and MRI quantification of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat fraction (LFF) at baseline and 12 months postoperatively. Correlation analyses examined associations between fat distribution, cardiometabolic variables, and echocardiographic parameters. Hierarchical linear regression identified independent predictors of cardiac recovery. Results: At 12 months, bariatric surgery produced marked reductions in body weight, BMI, waist circumference, VAT, and LFF (all p <0.001), accompanied by significant improvements in BP and insulin resistance. Echocardiography demonstrated regression of LV remodeling, including reductions in LV mass index (LVMI) and relative wall thickness (RWT), with improved diastolic function reflected by increased E/A ratio and Ea and reduced E/Ea ratio and left atrial (LA) diameter (all p <0.001). At baseline, VAT showed the strongest associations with cardiac abnormalities, correlating with LVMI, RWT, LA diameter, E/A ratio, Ea, and E/Ea ratio, whereas LFF showed no significant echocardiographic associations. Following surgery, Δsystolic BP correlated with ΔLVMI, while ΔHOMA-IR and ΔC-peptide correlated with ΔRWT (all p <0.05). Improvements in diastolic function were associated with reductions in ΔLFF, ΔVAT, and ΔHOMA-IR. Hierarchical regression identified baseline LVMI and RWT as the principal predictors of ΔLVMI (β=–0.567, p <0.001) and ΔRWT (β=–0.530, p <0.001), respectively. Addition of Δsystolic BP only modestly improved prediction of ΔLVMI, whereas ΔHOMA-IR showed a borderline association with ΔRWT. Both ΔVAT and ΔHOMA-IR independently contributed to ΔEa. Conclusions: Among MRI-derived fat depots, visceral adiposity was the predominant determinant of obesity-related LV remodeling and diastolic dysfunction. Following bariatric surgery, BP reduction primarily drove LV mass regression, improvement in insulin resistance was associated with reversal of concentric LV geometry, and reductions in visceral fat together with improved insulin sensitivity contributed to diastolic functional recovery. These findings highlight distinct cardiometabolic pathways underlying cardiac recovery after bariatric surgery.