Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T03:17:30.022Z Has data issue: false hasContentIssue false
  • English
  • Français

Relation of visceral fat and haemodynamics in adults with Fontan circulation

Published online by Cambridge University Press:  05 June 2020

Adam M. Lubert Open the ORCID record for Adam M. Lubert [Opens in a new window] ,
Tarek Alsaied Open the ORCID record for Tarek Alsaied [Opens in a new window] ,
Andrew T. Trout ,
Jonathan R. Dillman  and
Bryan H. Goldstein
Adam M. Lubert*
Affiliation:
Cincinnati Children’s Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Tarek Alsaied
Affiliation:
Cincinnati Children’s Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Andrew T. Trout
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Jonathan R. Dillman
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Bryan H. Goldstein
Affiliation:
Heart Institute, UPMC Children’s Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
Author for correspondence: Adam M. Lubert, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH45229-3026, USA. Tel: +1 513 803 2243; Fax +1 513 803 0079. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Being overweight is associated with reduced functional capacity in Fontan patients. Increased adiposity leads to accumulation of epicardial and intra-abdominal visceral fat, which produce proinflammatory cytokines and may affect endothelial function. This retrospective study to evaluate the association between visceral fat and Fontan haemodynamics included 23 Fontan patients >18 years old with MRI and catheterization data available. Epicardial fat volume indexed to body surface area was measured by cardiac MRI, and intra-abdominal visceral fat thickness and subcutaneous fat thickness were derived from abdominal MRI. Stepwise regression models were used to determine univariable and multivariable associations between fat measures and haemodynamics. Mean age was 28.2 ± 9.5 years and body mass index was 26 ± 4 kg/m2. Mean central venous pressure was 13 ± 3 mmHg and pulmonary vascular resistance index was 1.23WU·m2 (interquartile range: 0.95–1.56). Epicardial fat volume was associated with age (r2 = 0.37, p = 0.002), weight (r2 = 0.26, p = 0.013), body mass index (r2 = 0.27, p = 0.011), and intra-abdominal visceral fat (r2 = 0.30, p = 0.018). Subcutaneous fat thickness did not relate to these measures. There was modest correlation between epicardial fat volume and pulmonary vascular resistance (r2 = 0.27, p = 0.02) and a trend towards significant correlation between intra-abdominal fat thickness and pulmonary vascular resistance (r2 = 0.21, p = 0.06). Subcutaneous fat thickness was not associated with Fontan haemodynamics. In multivariable analysis, including age and visceral fat measures, epicardial fat was independently correlated with pulmonary vascular resistance (point estimate 0.13 ± 0.05 per 10 ml/m2 increase, p = 0.03). In conclusion, in adults with Fontan circulation, increased visceral fat is associated with higher pulmonary vascular resistance. Excess visceral fat may represent a therapeutic target to improve Fontan haemodynamics.

Keywords

Fontanadiposeadult CHDMRI
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 995 - 1000
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 1081–1086.CrossRefGoogle ScholarPubMed
Cohen, MS, Zak, V, Atz, AMet al.Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome. Am Heart J 2010; 160: 1092–1098, 1098.e1091.CrossRefGoogle ScholarPubMed
Martinez, SC, Byku, M, Novak, ELet al.Increased body mass index is associated with congestive heart failure and mortality in adult Fontan patients. Congenital Heart Disease 2016; 11: 71–79.CrossRefGoogle ScholarPubMed
Mazurek, T, Zhang, L, Zalewski, Aet al.Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003; 108: 2460–2466.CrossRefGoogle ScholarPubMed
Packer, M. Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium. J Am Coll Cardiol 2018; 71: 2360–2372.CrossRefGoogle ScholarPubMed
Neeland, IJ, Turer, AT, Ayers, CRet al.Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults. Journal of the American College of Cardiology 2015; 65: 2150–2151.CrossRefGoogle ScholarPubMed
Lubert, AM, Lu, JC, Rocchini, APet al.Relation of Increased Epicardial Fat After Fontan Palliation to Cardiac Output and Systemic Ventricular Ejection Fraction. Am J Cardiol 2018; 121: 862–866.CrossRefGoogle ScholarPubMed
Kuchenbecker, WK, Groen, H, Pel, Het al.Validation of the measurement of intra-abdominal fat between ultrasound and CT scan in women with obesity and infertility. Obesity (Silver Spring) 2014; 22: 537–544.CrossRefGoogle ScholarPubMed
Seckeler, MD, Hirsch, R, Beekman, RH, 3rd and Goldstein, BHA new predictive equation for oxygen consumption in children and adults with congenital and acquired heart disease. Heart 2015; 101: 517–524.CrossRefGoogle ScholarPubMed
Pinto, NM, Marino, BS, Wernovsky, Get al.Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120: e1157–1164.CrossRefGoogle ScholarPubMed
Pasquali, SK and Cohen, MSThe impact of obesity in children with congenital and acquired heart disease. Progress in Pediatric Cardiology 2008; 25: 119–124.CrossRefGoogle Scholar
Hales, CM, Carroll, MD, Fryar, CD and Ogden, CLPrevalence of Obesity Among Adults and Youth: united States, 2015–2016. NCHS data brief 2017: 1–8.Google ScholarPubMed
Pike, NA, Evangelista, LS, Doering, LV, Koniak-Griffin, D, Lewis, AB and Child, JSClinical Profile of the Adolescent/Adult Fontan Survivor. Congenital heart disease 2011; 6: 9–17.CrossRefGoogle ScholarPubMed
McCrindle, BW, Williams, RV, Mital, Set al.Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Archives of disease in childhood 2007; 92: 509–514.CrossRefGoogle ScholarPubMed
Leunissen, RW, Kerkhof, GF, Stijnen, T and Hokken-Koelega, ATiming and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. Jama 2009; 301: 2234–2242.CrossRefGoogle ScholarPubMed
Despres, JPBody fat distribution and risk of cardiovascular disease: an update. Circulation 2012; 126: 1301–1313.CrossRefGoogle ScholarPubMed
Lopes, HF, Correa-Giannella, ML, Consolim-Colombo, FM and Egan, BMVisceral adiposity syndrome. Diabetology & metabolic syndrome 2016; 8: 40.CrossRefGoogle ScholarPubMed
Ikeda, Y, Yonemitsu, Y, Kataoka, Cet al.Anti-monocyte chemoattractant protein-1 gene therapy attenuates pulmonary hypertension in rats. American Journal of Physiology-Heart and Circulatory Physiology 2002; 283: H2021–H2028.CrossRefGoogle ScholarPubMed
Zamanian, RT, Hansmann, G, Snook, Set al.Insulin resistance in pulmonary arterial hypertension. European Respiratory Journal 2008; 33: 318–324.CrossRefGoogle ScholarPubMed
Nigro, E, Scudiero, O, Monaco, MLet al.New insight into adiponectin role in obesity and obesity-related diseases. BioMed research international 2014; 2014: 658913–658913.CrossRefGoogle ScholarPubMed
Ohashi, K, Ouchi, N and Matsuzawa, YAdiponectin and hypertension. Am J Hypertens 2011; 24: 263–269.CrossRefGoogle ScholarPubMed
Weng, M, Raher, MJ, Leyton, Pet al.Adiponectin decreases pulmonary arterial remodeling in murine models of pulmonary hypertension. American journal of respiratory cell and molecular biology 2011; 45: 340–347.CrossRefGoogle ScholarPubMed
Medoff, BD Fat, Fire and muscle--the role of adiponectin in pulmonary vascular inflammation and remodeling. Pulmonary pharmacology & therapeutics 2013; 26: 420–426.CrossRefGoogle ScholarPubMed
Luo, L, Zheng, W, Lian, Get al.Combination treatment of adipose-derived stem cells and adiponectin attenuates pulmonary arterial hypertension in rats by inhibiting pulmonary arterial smooth muscle cell proliferation and regulating the AMPK/BMP/Smad pathway. International journal of molecular medicine 2018; 41: 51–60.Google ScholarPubMed
Gaines, J, Vgontzas, AN, Fernandez-Mendoza, Jet al.Inflammation mediates the association between visceral adiposity and obstructive sleep apnea in adolescents. American Journal of Physiology-Endocrinology and Metabolism 2016; 311: E851–E858.CrossRefGoogle ScholarPubMed
Watson, NF, Bushnell, T, Jones, TK and Stout, KA novel method for the evaluation and treatment of obstructive sleep apnea in four adults with complex congenital heart disease and Fontan repairs. Sleep & breathing = Schlaf & Atmung 2009; 13: 421–424.CrossRefGoogle ScholarPubMed
Smith, Sr. and Zachwieja, JVisceral adipose tissue: a critical review of intervention strategies. International Journal of Obesity 1999; 23: 329–335.CrossRefGoogle ScholarPubMed
Wittekind, S, Mays, W, Gerdes, Yet al.A Novel Mechanism for Improved Exercise Performance in Pediatric Fontan Patients After Cardiac Rehabilitation. Pediatr Cardiol 2018; 39: 1023–1030.CrossRefGoogle ScholarPubMed
Cordina, RL, O’Meagher, S, Karmali, Aet al.Resistance training improves cardiac output, exercise capacity and tolerance to positive airway pressure in Fontan physiology. Int J Cardiol 2013; 168: 780–788.CrossRefGoogle ScholarPubMed
Nelson, AJ, Worthley, MI, Psaltis, PJet al.Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson 2009; 11: 15.CrossRefGoogle ScholarPubMed