Effects of Laparoscopic Sleeve Gastrectomy on Vascular and Myocardial Recovery: Type 2 Diabetes and Echocardiographic Indices of Diastolic Function

Background and Objectives: Obesity affects both the arterial wall and the myocardium, but after bariatric surgery the two compartments are usually studied in separate cohorts. We measured both in the same patients before and six months after laparoscopic sleeve gastrectomy (LSG), and asked whether type 2 diabetes mellitus (T2DM) is associated with differences in postoperative cardiac changes. Subjects and Methods: Fifty consecutive adults with severe obesity scheduled for LSG were enrolled prospectively at a single centre. Thirty completed the six-month protocol; 20 were not reassessed during pandemic-related disruption of elective outpatient follow-up. Carotid intima-media thickness (CIMT), ankle-brachial index (ABI), aortic propagation velocity (APV) and transthoracic echocardiography were obtained at both timepoints by the same operator, blinded to diabetes status and laboratory results, on the same equipment. Left atrial volume index and tricuspid regurgitant velocity were not recorded, so diastolic function was assessed using continuous indices (E/A, mean e′, E/e′) rather than formal categorical grading. Results: Body mass index fell from 45.5 ± 6.6 to 32.5 ± 5.8 kg/m2 (p < 0.001). CIMT decreased (0.80 ± 0.12 to 0.66 ± 0.11 mm, d = −1.86) and APV increased (52.0 ± 10.1 to 67.4 ± 10.8 cm/s, d = 1.99; both p < 0.001). Mean ABI did not change (1.07 ± 0.21 to 1.06 ± 0.07, d = −0.08, p = 0.679). Interventricular septal and posterior wall thickness and left atrial diameter decreased, and E/A and mean e′ increased (all p ≤ 0.012), while E/e′, an estimate of filling pressure, was unchanged (p = 0.871). Patients with T2DM (n = 18) showed a smaller increase in mean e′ than those without (n = 12): Δmean e′ 0.44 ± 1.24 versus 1.71 ± 1.68 cm/s (p = 0.025). The T2DM group also lost less weight (ΔBMI −11.9 ± 3.1 versus −14.7 ± 3.0 kg/m2, p = 0.019); after adjustment for baseline mean e′ and ΔBMI, T2DM remained associated with a smaller increase in mean e′ (β = −1.07, 95% CI −2.10 to −0.03, p = 0.044), as did a mixed-effects time-by-diabetes interaction (β = −1.26, p = 0.018). No statistically significant difference in vascular changes according to diabetes status was detected. Conclusions: Carotid intima-media thickness and aortic propagation velocity improved within six months of LSG, alongside favourable changes in several cardiac structural and diastolic indices, while ABI and E/e′ were unchanged. T2DM was associated with a smaller increase in mean e′ after adjustment for weight loss. The cohort is small, lost 40% of enrolled patients to pandemic-related attrition and had no non-surgical control group, so regression to the mean cannot be separated from the postoperative changes observed and these observations remain hypothesis-generating.