Division of Cardiology, Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
Can J Cardiol. 2020 Sep;36(9):1482-1490. doi: 10.1016/j.cjca.2020.06.015. Epub 2020 Jun 29.
Up to 25% of children with congenital heart disease are obese, which may have negative physiologic consequences for patients with repaired tetralogy of Fallot (rTOF).
Patients with rTOF who underwent cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise testing from 2007 to 2018 were reviewed. Complex rTOF patients were excluded. Obese patients (body mass index [BMI] ≥ 95th percentile) were compared with normal-weight patients (BMI < 85th percentile). CMR data were indexed to actual body surface area (aBSA), height, and BSA assuming ideal body weight (iBSA).
We compared 32 obese patients matched with 64 normal-weight patients. Obese vs normal-weight patients had significantly lower right (RV; median 45% [interquartile range 42%-48%] vs 52% [47%-55%]; P < 0.0001) and left (LV; 52% [47%-56%] vs 56% [54%-60%]; P < 0.0001) ventricular ejection fractions (EFs). There were no statistically significant differences regarding aBSA-indexed volumes of the RV or LV at either end-diastole (EDV) or end-systole (ESV). However, when indexed to either height or iBSA, obese patients had significantly greater RVEDV and LVEDV, greater LV mass, and higher RV and LV stroke volumes. Obese patients had lower peak oxygen consumption and oxygen consumption at anaerobic threshold. These results did not change after adjusting for degree of pulmonary regurgitation.
Obesity is associated with increased biventricular size, decreased biventricular EFs, and impaired exercise performance after rTOF. These data suggest a potential role for cardiac rehabilitation for weight management and to optimize fitness.
高达 25%的先天性心脏病患儿肥胖，这可能对法洛四联症修复术后（rTOF）患者的生理产生负面影响。
对 2007 年至 2018 年接受心脏磁共振成像（CMR）和心肺运动测试的 rTOF 患者进行了回顾性分析。排除复杂型 rTOF 患者。将肥胖患者（体重指数 [BMI]≥第 95 百分位数）与正常体重患者（BMI<第 85 百分位数）进行比较。CMR 数据按实际体表面积（aBSA）、身高和假设理想体重的体表面积（iBSA）进行指数化。
我们比较了 32 名肥胖患者和 64 名正常体重患者。与正常体重患者相比，肥胖患者的右心室（RV；中位数 45%[四分位距 42%-48%]比 52%[47%-55%]；P<0.0001）和左心室（LV；52%[47%-56%]比 56%[54%-60%]；P<0.0001）射血分数（EF）显著降低。在舒张末期（EDV）或收缩末期（ESV），RV 或 LV 的 aBSA 指数容积无统计学差异。然而，当按身高或 iBSA 指数化时，肥胖患者的 RVEDV 和 LVEDV 显著增大，LV 质量更大，RV 和 LV 每搏量更高。肥胖患者的峰值耗氧量和无氧阈时的耗氧量更低。这些结果在调整肺反流程度后没有改变。
肥胖与 rTOF 后双心室增大、双心室 EF 降低以及运动能力受损有关。这些数据表明，心脏康复在体重管理和优化体能方面可能发挥作用。
