Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database

Survival of patients after repair of coarctation of Aorta (CoA) has improved signi cantly over the decades, but patients have decreased life expectancy as compared to the general population. This has been attributed to increased hypertension, cerebrovascular disease and coronary artery disease. There has also been an increasing concern of overweight and obesity in patients with adult congenital heart disease.While there have been studies looking at the impact of long-term hypertension on myocardial performance and outcomes in this population, this study aims to assess the impact of obesity in these patients on their myocardial performance. Ventriculo-arterial coupling is used as a measure of myocardial performance which re ects the interaction between cardiac contractility and arterial elastance. Patients after CoA repair are known to have hypertension affecting the arterial elastance. Obesity affects cardiac contractility as well. This study demonstrated that in a group of young patients after CoA repair, Body Mass Index (BMI) has a relationship with Left Ventricular (LV) contractility and myocardial performance. This relationship was independent of blood pressure. BMI itself was not seen to affect the determinants of diastolic function in this study, suggesting that LV contractility may be affected before one can notice a change in the diastolic function secondary to BMI.

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Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair

Bansal

Zaidi

Bansal

et al. 2023

Pediatr Cardiol

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Relationship of Left Ventricular Mass to Lean Body Mass in the Obese Pediatric Population

et al. 2023

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Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot

Johansson,

Hedström,

Steding-Ehrenborg

et al. 2024

Pediatr Cardiol

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A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9–13] years), 12 pediatric controls (10.5 [9–13] years), 12 adults with rToF (21.5 [19–27] years) and 12 adult controls (24 [21–29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm2/m [− 1.3 to 0.8] and − 0.6 [− 1.5 to − 0.2]) at beginning of diastole compared to controls (− 2.7 cm2/m [− 4.9 to − 1.7], p = 0.015) and − 3.3 cm2/m [− 3.8 to − 2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.

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Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database

Cited by 9 publications

References 22 publications

Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair

Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair

Relationship of Left Ventricular Mass to Lean Body Mass in the Obese Pediatric Population

Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot

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