Cardiovascular outcomes following bariatric surgery in obese patients with hypertrophic cardiomyopathy: A multicenter propensity-matched analysis

Obesity is highly prevalent among patients with hypertrophic cardiomyopathy (HCM) and is associated with adverse outcomes. Bariatric surgery (BS) has been shown to reduce cardiovascular risk in obese populations, but its impact in HCM remains uncertain. We performed a retrospective cohort study using the TriNetX Research Network, identifying adults with HCM and body mass index (BMI) ≥35 kg/m² prior to January 2024. Patients were stratified into BS and non-BS cohorts. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medications. Cox regression models and Kaplan-Meier analyses evaluated outcomes. Of 26,345 patients, 2568 in each cohort were well matched (mean age: 53 years, 74% female, BMI 41.0 kg/m²). Over a follow-up period up to 12 months, BS was associated with significantly reduced all-cause mortality (1.2% vs. 2.9%; HR = 0.40; 95% CI: 0.27-0.61, <i>p</i> < 0.001) and acute heart failure hospitalization (8.6% vs. 10.7%; HR = 0.76; 95% CI: 0.63-0.90, <i>p</i> < 0.002). BS achieved substantial BMI reduction (-5.0 kg/m², p < 0.001). Rates of arrhythmias and cardiac arrest were similar between both groups. In obese patients with HCM, bariatric surgery was associated with lower mortality and fewer heart failure hospitalizations, supporting obesity as a modifiable risk factor in this population.