Freddo Andrew M, Ahmed Humera, Edelson Jonathan B, Ortega-Legaspi Juan M, Vaikunth Sumeet
Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Cardiol. 2024 Nov 12. doi: 10.1007/s00246-024-03700-9.
There are a growing number of adult patients palliated to a Fontan circulation. As these patients age, many develop symptomatic heart failure (d'Udekem et al in Circulation 130:S32-S38, 2014) that is exacerbated by acquired comorbidities such as obesity and hypertension. Increased body mass index (BMI) and adiposity have been associated with worse hemodynamics and clinical outcomes in these patients (Yogeswaran et al in J Am Hear Assoc: Cardiovasc Cerebrovasc Dis 12:e026732, 2023). Recently, glucagon-like peptide-1 (GLP-1) agonists, originally developed to treat diabetes mellitus, received FDA approval for weight loss and have been shown to reduce the risk of cardiovascular events in the general population (Vilsbøll et al in BMJ 344:d7771, 2012). There are limited data on these medications in patients with a Fontan circulation. We conducted a retrospective review of adults with Fontan circulation followed in our adult congenital heart disease (ACHD) clinic between 2009 and 2023 and identified 8 patients prescribed GLP-1 agonists. We found that GLP-1 agonists were well-tolerated and led to modest reduction in weight and blood pressure. Further study of the use of these medications in this population is warranted.
接受Fontan循环姑息治疗的成年患者数量正在增加。随着这些患者年龄的增长，许多人会出现症状性心力衰竭（d'Udekem等人，《循环》130:S32 - S38，2014年），肥胖和高血压等后天合并症会使其病情加重。体重指数（BMI）增加和肥胖与这些患者较差的血流动力学和临床结局相关（Yogeswaran等人，《美国心脏协会杂志：心血管与脑血管疾病》12:e026732，2023年）。最近，最初用于治疗糖尿病的胰高血糖素样肽-1（GLP-1）激动剂获得了美国食品药品监督管理局（FDA）的减肥批准，并已被证明可降低普通人群中心血管事件的风险（Vilsbøll等人，《英国医学杂志》344:d7771，2012年）。关于这些药物在Fontan循环患者中的数据有限。我们对2009年至2023年在我们成人先天性心脏病（ACHD）诊所接受随访的Fontan循环成年患者进行了回顾性研究，确定了8名开具GLP-1激动剂处方的患者。我们发现GLP-1激动剂耐受性良好，并导致体重和血压适度下降。有必要对这些药物在该人群中的使用进行进一步研究。
