Impact of adiposity on clinical outcomes in people living with a Fontan circulation

Cao, Jacob; Tran, Derek; Briody, Julie; Attard, Chantal; Hassan, Ebrahim Bani; Simm, Peter; Burchill, Luke J.; Twigg, Stephen M.; Fiatarone-Singh, M; Ayer, Julian; Celermajer, David S.; d’Udekem, Yves; Cordina, Rachael

doi:10.1016/j.ijcard.2020.12.066

Cited by 14 publications

(26 citation statements)

References 30 publications

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“…It is becoming clear that the best outcomes after Fontan completion are achieved in patients who are physically active and lean. 16 There is a direct relationship between body mass index in patients and risk of Fontan failure, with Cao and colleagues 16 reporting that with every 1% increase in body fat percentage, there was a 10% increased risk of developing Fontan failure. From this perspective, individuals who are incapable of exercising (eg, after brain injury or because of a neuromuscular disorder) will be poor candidates for Fontan completion.…”

Section: Candidacy For Fontan Completionmentioning

confidence: 99%

Fontan candidacy, optimizing Fontan circulation, and beyond

2022

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Section: Candidacy For Fontan Completionmentioning

confidence: 99%

Fontan candidacy, optimizing Fontan circulation, and beyond

2022

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“… 2 Obesity in adult Fontan patients has also been shown to be associated with poor exercise capacity, increased risk of congestive heart failure, thromboembolic complications and Fontan failure resulting in death or transplantation. 3 , 4 , 23 , 24 Given this rise in obesity and its adverse effects on Fontan survivors, it is of paramount importance that physicians caring for these complex patients keep them and their families engaged with healthy nutrition practices.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population Across Ventricular Morphologies

Madan,

Aly,

Kathol

et al. 2024

JAHA

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Background Obesity is associated with diminished myocardial function as measured by strain echocardiography in children and young adults with normal cardiac anatomy. Data are lacking about the effect of obesity on myocardial strain in patients with a single ventricle. In this study, the relationship between body mass index (BMI) and single ventricle myocardial strain in the Fontan population was assessed. Methods and Results Thirty‐eight abnormal BMI Fontan cases (21 overweight and 17 obese) and 30 normal BMI Fontan controls matched based on single ventricular morphology, age, and sex were included in the study. Ventricular morphology was categorized as single right ventricle, single left ventricle, or biventricular. Single ventricle global longitudinal peak systolic strain (GLS) and other echocardiographic measurements were performed and compared between groups, with a P ≤0.05 defined as significant. The abnormal BMI group demonstrated diminished GLS (−15.7±3.6% versus −17.2±3.2%, [ P =0.03]) and elevated systolic blood pressure ( P =0.04) compared with the normal BMI group. On subgroup analysis of those with single right ventricle morphology, the abnormal BMI group demonstrated diminished GLS compared with controls. There was no significant difference in GLS between the abnormal BMI and control groups in the single left ventricle and biventricular subgroups. Analyzed by ventricular morphology, no other variables were statistically different in the abnormal BMI group including systolic blood pressure. Inter‐reader reproducibility for GLS and strain rate were excellent for both measures. Conclusions Obesity has an adverse relationship with myocardial strain in the young Fontan population, with the most maladaptive response seen in the single right ventricle.

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“…We have previously reported increased adiposity is associated with a higher risk of adverse outcomes in people with a Fontan circulation ( 33 ). None of the people with the “Super-Fontan” phenotype were obese based on BMI compared to 22% in the comparator group with impaired exercise performance.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, higher BMI often co-exists with increased visceral adiposity (epicardial and intra-abdominal fat), which may be particularly pathological—visceral adiposity is positively associated with pulmonary vascular resistance and inversely associated with ejection fraction and cardiac index in the Fontan circulation ( 35 , 36 ). Of course, BMI may not be a robust measure of adiposity in the setting of complex congenital heart disease, where myopenia is common ( 33 , 37 , 38 ). The association between adiposity and pulmonary vascular resistance may be attributed to the adverse effects of pro-inflammatory adipokines ( 39 ), co-existing obstructive sleep apnea ( 40 , 41 ), or decreased adiponectin ( 39 , 42 ).…”

Section: Discussionmentioning

confidence: 99%

The “Super-Fontan” Phenotype: Characterizing Factors Associated With High Physical Performance

Tran

Celermajer

Ayer

et al. 2021

Front. Cardiovasc. Med.

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Background: People with a Fontan circulation usually have moderately impaired exercise performance, although a subset have high physical performance (“Super-Fontan”), which may represent a low-risk phenotype.Methods: People with a “Super-Fontan” phenotype were defined as achieving normal exercise performance [≥80% predicted peak oxygen uptake (VO2) and work rate] during cardiopulmonary exercise testing (CPET) and were identified from the Australian and New Zealand Fontan Registry. A Fontan control group that included people with impaired exercise performance (<80% predicted VO2 or work rate) was also identified based on a 1:3 allocation ratio. A subset of participants were prospectively recruited and completed a series of physical activity, exercise self-efficacy, and health-related quality of life questionnaires.Results: Sixty CPETs (“Super-Fontan”, n = 15; control, n = 45) were included. A subset (“Super-Fontan”, n = 10; control, n = 13) completed a series of questionnaires. Average age was 29 ± 8 years; 48% were males. Exercise capacity reflected by percent predicted VO2 was 67 ± 17% in the entire cohort. Compared to the “Super-Fontan” phenotype, age at Fontan completion was higher in controls (4.0 ± 2.9 vs. 7.2 ± 5.3 years, p = 0.002). Only one (7%) person in the “Super-Fontan” group had a dominant right ventricle compared to 15 (33%) controls (p = 0.043). None of those in the “Super-Fontan” group were obese, while almost a quarter (22%) of controls were obese based on body mass index (p = 0.046). Lung function abnormalities were less prevalent in the “Super-Fontan” group (20 vs. 70%, p = 0.006). Exercise self-efficacy was greater in the “Super-Fontan” group (34.2 ± 3.6 vs. 27.9 ± 7.2, p = 0.02). Self-reported sports participation and physical activity levels during childhood and early adulthood were higher in the “Super-Fontan” group (p < 0.05). The total average time spent participating in structured sports and physical activity was 4.3 ± 2.6 h/wk in the “Super-Fontan” group compared to 2.0 ± 3.0 h/wk in controls, p = 0.003. There were no differences in self-reported current total physical activity score or health-related quality of life between groups (p ≥ 0.05).Conclusions: The “Super-Fontan” phenotype is associated with a healthy weight, lower age at Fontan completion, better exercise self-efficacy, and higher overall levels of sport and physical activity participation during physical development.

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Impact of adiposity on clinical outcomes in people living with a Fontan circulation

Cited by 14 publications

References 30 publications

Fontan candidacy, optimizing Fontan circulation, and beyond

Fontan candidacy, optimizing Fontan circulation, and beyond

Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population Across Ventricular Morphologies

The “Super-Fontan” Phenotype: Characterizing Factors Associated With High Physical Performance

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