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Obesity leads to underestimation of ventricular volumes and abnormal myocardial strain in repaired Tetralogy of Fallot as measured by cardiac MRI

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Obesity is an increasing epidemic that has not spared children and adults with congenital heart disease... Patients with repaired tetralogy of Fallot with trans-annular patch (rTOF-TAP) have significant pulmonary insufficiency and right ventricular (RV) enlargement... We hypothesized that: 1) overweight and obese patients with rTOF-TAP have underestimated indexed ventricular volumes when compared to volumes indexed to ideal BSA and 2) these patients have altered parameters of cardiac function compared to weight appropriate patients... CMR analysis included: 1) RV volumes and RV ejection fraction (RVEF); 2) Left ventricular (LV) volumes and LVEF; 3) Peak circumferential LV strain (εcc) using HARP analysis of myocardial tagged images... Obese and overweight patients had significantly larger absolute RVEDV and LVEDV compared to weight appropriate patients (RV mean 234 ml vs. 200 ml, p = 0.014; LV mean 113 ml vs. 92 ml, p = 0.002)... No significant difference in RVEF and LVEF among groups... When RV volumes were corrected for ideal BSA, 11 (31%) additional overweight and obese patients met standard criteria for PVR referral (Figure 1); mean change RVEDVi 22.9 ml/m2 (range 4.8-62 ml/m2), mean change RVESVi 11.3 ml/m2 (range 2.9-38.4 ml/m2)... There was a statistically significant difference between εcc in appropriate weight (-17.3%) and obese (-14.3%) patients, (-2.94%, 95%CI{-5.2,-0.6} p = 0.007) (Figure 2); segmental analysis between appropriate weight and obese patients demonstrated decreased εcc in anteroseptal, inferior, and inferolateral segments (p < 0.001, p = 0.003, p = 0.016, respectively)... No significant differences in εcc noted between appropriate weight and overweight patients... Decreased LV εcc has not been previously reported in obese patients with rTOF-TAP... Although clinical implications of abnormal εcc are unclear, these patients may be at higher risk for early LV dysfunction... Further studies on εcc in this patient population are recommended.

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Mentions: Mean BMI in appropriate weight 19.8 kg/m2, overweight 26.4 kg/m2, obese 33.5 kg/m2. Obese and overweight patients had significantly larger absolute RVEDV and LVEDV compared to weight appropriate patients (RV mean 234 ml vs. 200 ml, p = 0.014; LV mean 113 ml vs. 92 ml, p = 0.002). No significant difference in RVEF and LVEF among groups. When RV volumes were corrected for ideal BSA, 11 (31%) additional overweight and obese patients met standard criteria for PVR referral (Figure 1); mean change RVEDVi 22.9 ml/m2 (range 4.8-62 ml/m2), mean change RVESVi 11.3 ml/m2 (range 2.9-38.4 ml/m2). There was a statistically significant difference between εcc in appropriate weight (-17.3%) and obese (-14.3%) patients, (-2.94%, 95%CI{-5.2,-0.6} p = 0.007) (Figure 2); segmental analysis between appropriate weight and obese patients demonstrated decreased εcc in anteroseptal, inferior, and inferolateral segments (p < 0.001, p = 0.003, p = 0.016, respectively). No significant differences in εcc noted between appropriate weight and overweight patients.


Obesity leads to underestimation of ventricular volumes and abnormal myocardial strain in repaired Tetralogy of Fallot as measured by cardiac MRI
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4043754&req=5

Mentions: Mean BMI in appropriate weight 19.8 kg/m2, overweight 26.4 kg/m2, obese 33.5 kg/m2. Obese and overweight patients had significantly larger absolute RVEDV and LVEDV compared to weight appropriate patients (RV mean 234 ml vs. 200 ml, p = 0.014; LV mean 113 ml vs. 92 ml, p = 0.002). No significant difference in RVEF and LVEF among groups. When RV volumes were corrected for ideal BSA, 11 (31%) additional overweight and obese patients met standard criteria for PVR referral (Figure 1); mean change RVEDVi 22.9 ml/m2 (range 4.8-62 ml/m2), mean change RVESVi 11.3 ml/m2 (range 2.9-38.4 ml/m2). There was a statistically significant difference between εcc in appropriate weight (-17.3%) and obese (-14.3%) patients, (-2.94%, 95%CI{-5.2,-0.6} p = 0.007) (Figure 2); segmental analysis between appropriate weight and obese patients demonstrated decreased εcc in anteroseptal, inferior, and inferolateral segments (p < 0.001, p = 0.003, p = 0.016, respectively). No significant differences in εcc noted between appropriate weight and overweight patients.

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Obesity is an increasing epidemic that has not spared children and adults with congenital heart disease... Patients with repaired tetralogy of Fallot with trans-annular patch (rTOF-TAP) have significant pulmonary insufficiency and right ventricular (RV) enlargement... We hypothesized that: 1) overweight and obese patients with rTOF-TAP have underestimated indexed ventricular volumes when compared to volumes indexed to ideal BSA and 2) these patients have altered parameters of cardiac function compared to weight appropriate patients... CMR analysis included: 1) RV volumes and RV ejection fraction (RVEF); 2) Left ventricular (LV) volumes and LVEF; 3) Peak circumferential LV strain (εcc) using HARP analysis of myocardial tagged images... Obese and overweight patients had significantly larger absolute RVEDV and LVEDV compared to weight appropriate patients (RV mean 234 ml vs. 200 ml, p = 0.014; LV mean 113 ml vs. 92 ml, p = 0.002)... No significant difference in RVEF and LVEF among groups... When RV volumes were corrected for ideal BSA, 11 (31%) additional overweight and obese patients met standard criteria for PVR referral (Figure 1); mean change RVEDVi 22.9 ml/m2 (range 4.8-62 ml/m2), mean change RVESVi 11.3 ml/m2 (range 2.9-38.4 ml/m2)... There was a statistically significant difference between εcc in appropriate weight (-17.3%) and obese (-14.3%) patients, (-2.94%, 95%CI{-5.2,-0.6} p = 0.007) (Figure 2); segmental analysis between appropriate weight and obese patients demonstrated decreased εcc in anteroseptal, inferior, and inferolateral segments (p < 0.001, p = 0.003, p = 0.016, respectively)... No significant differences in εcc noted between appropriate weight and overweight patients... Decreased LV εcc has not been previously reported in obese patients with rTOF-TAP... Although clinical implications of abnormal εcc are unclear, these patients may be at higher risk for early LV dysfunction... Further studies on εcc in this patient population are recommended.

No MeSH data available.