Obesity and idiopathic cardiomyopathy – is there hope?

Mohd Shah, Azarisman Shah and Abdullah, Aszrin (2024) Obesity and idiopathic cardiomyopathy – is there hope? Medicine & Health, 19 (5). p. 74. ISSN 1823-2140 E-ISSN 2289-5728

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Abstract

Introduction: A 40-year-old female was referred for symptoms and signs of heart failure in March 2022. There was no prior history of any infection, exposure to chemicals or blood products and no apparent risk factors. Total cholesterol was 5.9 mmol/L, fasting blood glucose 6.1 mmol/L, HbA1c 5.8%, blood pressure 130/90 mmHg, Thyroid Stimulating Hormone (TSH) 1.73 +μIU/l, Haemoglobin 14.6 g/dL but the N-terminal pro b-type natriuretic peptide (NT-proBNP) was elevated, 628 pg/mL. Electrocardiogram showed sinus rhythm but trans-thoracic echocardiography (TTE) showed poor left ventricular ejection fraction (LVEF) of 28%, dilated left ventricle (6.0 cm) and left atria (4.67 cm) but otherwise the valves, interatrial and interventricular septa were normal. Her urine pregnancy test was negative. She was morbidly obese with a BMI of 49.1 kg/m2 (height 155 cm, weight 118 kg). Post-gadolinium cardiac magnetic resonance imaging of the heart revealed findings typically found in patients with idiopathic cardiomyopathy. Sacubitril and valsartan (Entresto®) 50 mg BID, spironolactone 25 mg OD, bisoprolol 1.25 mg OD, atorvastation 40 mg ON and frusemide 40 mg OD was started. Entresto® eventually optimized to 150 mg BID within 6 months, LVEF improved to 40% and the NT-proBNP became normalised – 105 pg/mL. However, she was still symptomatic and her weight fluctuated between 116 kg and 126 kg. Roux-en-Y gastric bypass surgery was then undertaken in August 2023 following a 1-year period of failed diet and exercise attempts. Within 6 months, her weight had gone down by 34 kg to 88 kg, BMI - 36.6 kg/m2, her LVEF improved to 55%. Conclusion: Optimal medical treatment for idiopathic cardiomyopathy in patients with morbid obesity may result in inadequate symptom control. Induced weight loss may be necessary and Rouxen-Y gastric bypass surgery decreases the incidence of new heart failure development compared to intensive lifestyle modification by almost 50%.

Item Type:	Article (Abstract)
Uncontrolled Keywords:	Cardiomyopathy; obesity; entresto; Roux-en-Y
Subjects:	R Medicine > R Medicine (General) R Medicine > RB Pathology R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC667 Specialties of Internal Medicine-Diseases of Circulatory (Cardiovascular) System
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Basic Medical Kulliyyah of Medicine
Depositing User:	DR Aszrin Abdullah
Date Deposited:	26 Jan 2025 14:50
Last Modified:	26 Jan 2025 14:50
URI:	http://irep.iium.edu.my/id/eprint/118887

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