Pasquali Sara K, Marino Bradley S, Powell Darryl J, McBride Michael G, Paridon Stephen M, Meyers Kevin E, Mohler Emile R, Walker Susan A, Kren Stephanie, Cohen Meryl S
Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Congenit Heart Dis. 2010 Jan-Feb;5(1):16-24. doi: 10.1111/j.1747-0803.2009.00359.x.
Children who have undergone the arterial switch operation (ASO) are at risk for premature coronary artery disease due to coronary re-implantation. Obesity may also pose cardiovascular risk. The purpose of this study was to evaluate comorbidities and markers of early cardiovascular disease in obese ASO patients.
Obese [body mass index (BMI) >or= 95th %] and normal weight (NW, BMI < 85th %) ASO patients, and NW controls without heart disease were enrolled, and underwent prospective vascular, echocardiographic, laboratory, exercise, and ambulatory blood pressure (BP) testing. Results were compared between groups. BP load was defined as proportion of recordings >or= 95th %.
Thirty patients [13.2 years (11.2-16.8), 57% male] were evaluated: 10 obese ASO, 10 NW ASO, and 10 NW controls. Obese ASO patients, in comparison to NW ASO and controls, had higher systolic BP% [96% (90-99) vs. 67% (30-91) P= 0.07 (trend) and 34% (21-43) P= 0.005], night-time diastolic BP load [18% (14-24) vs. 0% (0-0) P= 0.01 and 0% (0-0) P= 0.01], left ventricular mass index [51.7 g/m(2.7) (46.6-53.3) vs. 40.7 g/m(2.7) (29.2-41.6) P < 0.01 and 28.9 g/m(2.7) (27.3-33.7) P < 0.01], and lower brachial artery reactivity [8.7% (6.2-11.9) vs. 14.6% (10.8-23.0) P= 0.03, and 16.7% (12.8-17.8) P= 0.05]. There was a trend toward increased carotid intima-media thickness, and significantly higher triglyceride and lower high-density lipoprotein levels in obese ASO patients.
Following the ASO, obese patients have associated comorbidities, and markers of early cardiovascular disease. These may pose additional risk for future cardiovascular events in this unique population who underwent coronary artery re-implantation in infancy.
接受动脉调转术（ASO）的儿童因冠状动脉再植入存在过早发生冠状动脉疾病的风险。肥胖也可能带来心血管风险。本研究的目的是评估肥胖ASO患者的合并症及早期心血管疾病标志物。
纳入肥胖[体重指数（BMI）≥第95百分位数]和正常体重（NW，BMI＜第85百分位数）的ASO患者，以及无心脏病的NW对照者，进行前瞻性血管、超声心动图、实验室、运动及动态血压（BP）检测。对组间结果进行比较。血压负荷定义为记录值≥第95百分位数的比例。
共评估了30例患者[13.2岁（11.2 - 16.8岁），57%为男性]：10例肥胖ASO患者、10例NW ASO患者和10例NW对照者。与NW ASO患者和对照者相比，肥胖ASO患者的收缩压百分比更高[96%（90 - 99）对67%（30 - 91），P = 0.07（趋势）和34%（21 - 43），P = 0.005]，夜间舒张压负荷更高[18%（14 - 24）对0%（0 - 0），P = 0.01和0%（0 - 0），P = 0.01]，左心室质量指数更高[51.7 g/m(2.7)（46.6 - 53.3）对40.7 g/m(2.7)（29.2 - 41.6），P ＜ 0.01和2,8.9 g/m(2.7)（27.3 - 33.7），P ＜ 0.01]，肱动脉反应性更低[8.7%（6.2 - 11.9）对14.6%（10.8 - 23.0），P = 0.03，和16.7%（12.8 - 17.8），P = 0.05]。肥胖ASO患者的颈动脉内膜中层厚度有增加趋势，甘油三酯水平显著更高而高密度脂蛋白水平更低。
ASO术后，肥胖患者存在相关合并症及早期心血管疾病标志物。对于在婴儿期接受冠状动脉再植入的这一特殊人群，这些可能会给未来心血管事件带来额外风险。
