Bariatric Surgery in Obesity-HFpEF — EECC MCQ

Correct answer: A — Emerging evidence suggests that substantial weight loss through bariatric surgery improves cardiac structure and function, exercise capacity, and HF symptoms in obese HFpEF — the obesity-HFpEF phenotype is increasingly recognised as a distinct and potentially modifiable entity

The obesity-HFpEF phenotype represents a significant proportion of HFpEF patients characterised by: excess epicardial/pericardial fat, increased plasma volume, elevated filling pressures, and impaired exercise capacity driven primarily by metabolic/adipose-mediated mechanisms rather than primary myocardial disease. Observational studies show bariatric surgery in obese HFpEF produces: (1) significant weight loss (25-35%); (2) improvement in diastolic function; (3) reduction in LV mass; (4) improved exercise capacity; (5) reduction in NT-proBNP; (6) reduction in HF hospitalisations. While no large RCT specifically addresses bariatric surgery in HFpEF, the STEP-HFpEF trial (semaglutide) validated the concept that weight reduction improves obesity-HFpEF outcomes. The ESC HF Guidelines recognise obesity as a modifiable risk factor for HFpEF.

Reference: ESC (2023): HF Guidelines; STEP-HFpEF Trial