Association of Body Mass Index With Clinical Features and Outcomes in Adults With Fontan Palliation

Abstract

Background With improving survival of patients with single ventricle physiology who underwent Fontan palliation, there is also an increase in the prevalence of overweight and obesity in these patients. This tertiary care single‐center study aims to determine the association of body mass index (BMI) with the clinical characteristics and outcomes in adults with Fontan. Methods and Results Adult patients (aged ≥18 years) with Fontan who were managed at a single tertiary care center between January 1, 2000, and July 1, 2019, and had BMI data available were identified via retrospective review of medical records. Univariate and multivariable (after adjusting for age, sex, functional class, and type of Fontan) linear and logistic regression, as appropriate, were utilized to evaluate associations between BMI and diagnostic testing and clinical outcomes. A total of 163 adult patients with Fontan were included (mean age, 29.9±9.08 years), with a mean BMI of 24.2±5.21 kg/m 2 (37.4% of patients had BMI ≥25 kg/m 2 ). Echocardiography data were available for 95.7% of patients, exercise testing for 39.3% of patients, and catheterization for 53.7% of patients. Each SD increase in BMI was significantly associated with decreased peak oxygen consumption ( P =0.010) on univariate analysis and with increased Fontan pressure ( P =0.035) and pulmonary capillary wedge pressure ( P =0.037) on multivariable analysis. In addition, BMI ≥25 kg/m 2 was independently associated with heart failure hospitalization (adjusted odds ratio [AOR], 10.2; 95% CI, 2.79–37.1 [ P <0.001]) and thromboembolic complications (AOR, 2.79; 95% CI, 1.11–6.97 [ P =0.029]). Conclusions Elevated BMI is associated with poor hemodynamics and worse clinical outcomes in adult patients with Fontan. Whether elevated BMI is the cause or consequence of poor clinical outcomes needs to be further established.

Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population Across Ventricular Morphologies

“… 2 Obesity in adult Fontan patients has also been shown to be associated with poor exercise capacity, increased risk of congestive heart failure, thromboembolic complications and Fontan failure resulting in death or transplantation. 3 , 4 , 23 , 24 Given this rise in obesity and its adverse effects on Fontan survivors, it is of paramount importance that physicians caring for these complex patients keep them and their families engaged with healthy nutrition practices.…”

Childhood Obesity and Congenital Heart Disease: A Lifelong Struggle

“…Children with single ventricle physiology often face growth restrictions in terms of weight and height, potentially attributed to hemodynamic limitations, such as chronic reduction in cardiac output and oxygen delivery [83]. However, as Fontan patients reach adulthood, the prevalence of overweight and obesity in this population approaches that of the general population, with 39% classified as overweight or obese and 17% falling into the obese category [84].…”