Congenital heart disease
Impact of Obesity on Ventricular Size and Function in Children, Adolescents and Adults With Tetralogy of Fallot After Initial Repair

https://doi.org/10.1016/j.amjcard.2013.04.030Get rights and content

Obesity is epidemic in congenital heart disease, with reported rates of 16% to 26% in children and 54% in adults. The aim of this study was to evaluate the impact of obesity on ventricular function and size in patients after initial repair for tetralogy of Fallot (TOF). Cardiac magnetic resonance studies in normal-weight (body mass index percentile <85th) and obese (body mass index percentile ≥95th) children and adults with repaired tetralogy of Fallot were reviewed. The left ventricular ejection fraction, the right ventricular ejection fraction, left and right ventricular end-diastolic volumes indexed to actual body surface area, to height, and to body surface area using ideal body weight were evaluated in 36 obese patients and 72 age-matched normal-weight patients. Compared with normal-weight patients, obese patients had lower right ventricular ejection fractions (mean 46 ± 9% vs 51 ± 7%, p = 0.003) and left ventricular ejection fractions (mean 57 ± 9% vs 61 ± 6%, p = 0.017), higher right ventricular end-diastolic volumes indexed to height (mean 160 ± 59 vs 135 ± 41 ml/m, p = 0.015) and left ventricular end-diastolic volumes indexed to height (mean 86 ± 25 vs 70 ± 20 ml/m, p = 0.001), and higher right ventricular end-diastolic volumes indexed to ideal body weight (mean 166 ± 55 vs 144 ± 38 ml/m2, p = 0.020) and left ventricular end-diastolic volumes indexed to ideal body weight (mean 90 ± 22 vs 75 ± 15 ml/m2, p <0.001). In conclusion, obesity is a modifiable risk factor associated with worsened biventricular systolic function and biventricular dilation in patients with repaired tetralogy of Fallot. The standard method of indexing ventricular volumes using actual body surface area may underestimate volume load in obese patients.

Section snippets

Methods

We performed a retrospective review of our radiology database from January 2004 through May 2011 for patients with TOF or TOF/pulmonary atresia who underwent cardiac magnetic resonance as part of routine clinical care after initial TOF repair, before subsequent intervention on the pulmonary valve or branch pulmonary artery. We excluded patients aged <2 years at the time of cardiac magnetic resonance, those without height and/or weight measurements at the time of cardiac magnetic resonance,

Results

We included 36 obese patients in our study. Of these, 2 (6%) were aged 2 to 6 years at the time of cardiac magnetic resonance, 3 (8%) were aged 6 to 10 years, 19 (53%) were aged 11 to 20 years, 6 (17%) were aged 21 to 30 years, and 6 (17%) were aged ≥31 years. Demographic and clinical characteristics, including pulmonary regurgitant fraction, the presence of restrictive physiology, and Nakata index, are listed in Table 1. To provide an estimate of pulmonary arterial caliber independent of

Discussion

We performed a retrospective review of patients after TOF repair who underwent cardiac magnetic resonance previous to repeat intervention on the pulmonary valve or a branch pulmonary artery to determine the impact of obesity on ventricular size and function. We found that obesity was associated with a lower RVEF, a lower LVEF, higher RVEDVh, higher RVEDVibw, higher LVEDVh, and higher LVEDVibw. Obese patients were more likely to exhibit RV and LV dysfunction than age-matched normal-weight

Disclosures

The authors have no conflicts of interest to disclose.

References (30)

  • W.A. Helbing et al.

    Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping

    J Am Coll Cardiol

    (1996)
  • E.B. Turkbey et al.

    The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA)

    JACC Cardiovasc Imaging

    (2010)
  • J.K. Alexander

    The cardiomyopathy of obesity

    Prog Cardiovasc Dis

    (1985)
  • L.R. Peterson et al.

    Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging

    J Am Coll Cardiol

    (2004)
  • R.J. Shustak et al.

    Prevalence of obesity among patients with congenital and acquired heart disease

    Pediatr Cardiol

    (2012)

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