Opp Derek N, Jain C Charles, Egbe Alexander C, Borlaug Barry A, Reddy Yogesh V, Connolly Heidi M, Lara-Breitinger Kyla M, Cordina Rachael, Miranda William R
Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Eur J Prev Cardiol. 2025 Feb 18;32(3):221-230. doi: 10.1093/eurjpc/zwae314.
The effects of obesity on Fontan haemodynamics are poorly understood. Accordingly, we assessed its impact on exercise invasive haemodynamics and exercise capacity.
Seventy-seven adults post-Fontan undergoing exercise cardiac catheterization (supine cycle protocol) were retrospectively identified using an institutional database and categorized according to the presence of obesity [body mass index (BMI) > 30 kg/m2] and overweight/normal BMI (BMI ≤ 30 kg/m2). There were 18 individuals with obesity (BMI 36.4 ± 3 kg/m2) and 59 with overweight/normal BMI (BMI 24.1 ± 3.6 kg/m2). Peak oxygen consumption (VO2) on non-invasive cardiopulmonary exercise testing was lower in patients with obesity (15.6 ± 3.5 vs. 19.6 ± 5.8 mL/kg/min, P = 0.04). At rest, systemic flow (Qs) [7.0 (4.8; 8.3) vs. 4.8 (3.9; 5.8) L/min, P = 0.001], pulmonary artery (PA) pressure (16.3 ± 3.5 vs. 13.1 ± 3.5 mmHg, P = 0.002), and PA wedge pressure (PAWP) (11.7 ± 4.4 vs. 8.9 ± 3.1 mmHg, P = 0.01) were higher, while arterial O2 saturation was lower [89.5% (86.5; 92.3) vs. 93% (90; 95)] in obesity compared with overweight/normal BMI. Similarly, patients with obesity had higher exercise PA pressure (29.7 ± 6.5 vs. 24.7 ± 6.8 mmHg, P = 0.01) and PAWP (23.0 ± 6.5 vs. 19.8 ± 7.3 mmHg, P = 0.047), but lower arterial O2 saturation [82.4 ± 7.0% vs. 89% (85; 92), P = 0.003].
Adults post-Fontan with obesity have worse aerobic capacity, increased Qs, higher filling pressures, and decreased arterial O2 saturation compared with those with overweight/normal BMI, both at rest and during exercise, mirroring the findings observed in the obesity phenotype of heart failure with preserved ejection fraction. Whether treating obesity and its cardiometabolic sequelae in Fontan patients will improve haemodynamics and outcomes requires further study.
肥胖对Fontan循环血流动力学的影响尚不清楚。因此，我们评估了肥胖对运动时有创血流动力学和运动能力的影响。
利用机构数据库对77例接受运动心导管检查（仰卧位循环方案）的Fontan术后成年患者进行回顾性分析，并根据是否存在肥胖[体重指数（BMI）>30 kg/m2]和超重/正常BMI（BMI≤30 kg/m2）进行分类。有18例肥胖患者（BMI 36.4±3 kg/m2）和59例超重/正常BMI患者（BMI 24.1±3.6 kg/m2）。肥胖患者在无创心肺运动试验中的峰值摄氧量（VO2）较低（15.6±3.5对19.6±5.8 mL/kg/min，P=0.04）。静息时，肥胖患者的全身血流量（Qs）[7.0（4.8；8.3）对4.8（3.9；5.8）L/min，P=0.001]、肺动脉（PA）压（16.3±3.5对13.1±3.5 mmHg，P=0.002）和PA楔压（PAWP）（11.7±4.4对8.9±3.1 mmHg，P=0.01）较高，而动脉血氧饱和度较低[89.5%（86.5；92.3）对93%（90；95）]。同样，肥胖患者运动时的PA压（29.7±6.5对24.7±6.8 mmHg，P=0.01）和PAWP（23.0±6.5对19.8±7.3 mmHg，P=0.
