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Canadian Journal of Cardiology

Negative Impact of Obesity on Ventricular Size and Function and Exercise Performance in Children and Adolescents With Repaired Tetralogy of Fallot

      Abstract

      Background

      Up to 25% of children with congenital heart disease are obese, which may have negative physiologic consequences for patients with repaired tetralogy of Fallot (rTOF).

      Methods

      Patients with rTOF who underwent cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise testing from 2007 to 2018 were reviewed. Complex rTOF patients were excluded. Obese patients (body mass index [BMI] ≥ 95th percentile) were compared with normal-weight patients (BMI < 85th percentile). CMR data were indexed to actual body surface area (aBSA), height, and BSA assuming ideal body weight (iBSA).

      Results

      We compared 32 obese patients matched with 64 normal-weight patients. Obese vs normal-weight patients had significantly lower right (RV; median 45% [interquartile range 42%-48%] vs 52% [47%-55%]; P < 0.0001) and left (LV; 52% [47%-56%] vs 56% [54%-60%]; P < 0.0001) ventricular ejection fractions (EFs). There were no statistically significant differences regarding aBSA-indexed volumes of the RV or LV at either end-diastole (EDV) or end-systole (ESV). However, when indexed to either height or iBSA, obese patients had significantly greater RVEDV and LVEDV, greater LV mass, and higher RV and LV stroke volumes. Obese patients had lower peak oxygen consumption and oxygen consumption at anaerobic threshold. These results did not change after adjusting for degree of pulmonary regurgitation.

      Conclusions

      Obesity is associated with increased biventricular size, decreased biventricular EFs, and impaired exercise performance after rTOF. These data suggest a potential role for cardiac rehabilitation for weight management and to optimize fitness.

      Résumé

      Contexte

      Jusqu'à 25 % des enfants atteints de cardiopathie congénitale sont obèses, ce qui peut avoir des conséquences physiologiques néfastes pour les patients atteints de tétralogie de Fallot réparée (rTOF pour repaired tetralogy of Fallot).

      Méthodes

      Les patients atteints de rTOF qui ont subi une résonance magnétique cardiaque (RMC) et des tests d'effort cardiopulmonaire de 2007 à 2018 ont été examinés. Les patients ayant subi une rTOF complexe ont été exclus. Les patients obèses (indice de masse corporelle [IMC] ≥ 95e percentile) ont été comparés aux patients de poids normal (IMC < 85e percentile). Les données de RMC ont été indexées en fonction de la surface corporelle avérée (aBSA pour actual body surface area), de la taille et de la surface corporelle en supposant un poids corporel idéal (iBSA pour ideal body surface area).

      Résultats

      Nous avons comparé 32 patients obèses à 64 patients de poids normal. Par rapport aux patients de poids normal, les patients obèses avaient des fractions d'éjection (FE) ventriculaire droite (VD) et gauche (VG) significativement plus faibles [FE ventriculaire droite (FEVD) 45 % (écart interquartile 42-48) contre 52 % (47-55), P < 0.0001; et FEVG 52 % (47-56) contre 56 % (54-60), P < 0.0001, respectivement]. Aucune différence statistiquement significative n'a été constatée concernant les volumes du VD ou du VG indexés sur l'aBSA, que ce soit en fin de diastole (VFD) ou en fin de systole. Cependant, lorsqu'ils étaient indexés sur la taille ou sur l'iBSA, les patients obèses présentaient des VFD-VD et VFD-VG significativement plus élevés, une masse du VG plus importante et des volumes systoliques du VD et du VG plus élevés. Les patients obèses présentaient une consommation maximale d'oxygène plus faible et une consommation d'oxygène au seuil anaérobie réduite. Ces résultats n'ont pas varié après ajustement en fonction du degré d’insuffisance pulmonaire.

      Conclusions

      L'obésité est associée à une augmentation de la taille des deux ventricules, à une diminution de la FE des deux ventricules et à une diminution des performances à l'effort après un rTOF. Ces données suggèrent un rôle potentiel de la réadaptation cardiaque pour la gestion du poids et pour une optimisation de la condition physique.
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