Relation of visceral fat and haemodynamics in adults with Fontan circulation

Lubert, Adam M.; Alsaied, Tarek; Trout, Andrew T.; Dillman, Jonathan R.; Goldstein, Bryan H.

doi:10.1017/s1047951120001419

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…In addition, the importance of maintaining a healthy body weight to preserve low pulmonary vascular resistance is increasingly recognized ( 32 ). Importantly, higher BMI often co-exists with increased visceral adiposity (epicardial and intra-abdominal fat), which may be particularly pathological—visceral adiposity is positively associated with pulmonary vascular resistance and inversely associated with ejection fraction and cardiac index in the Fontan circulation ( 35 , 36 ). Of course, BMI may not be a robust measure of adiposity in the setting of complex congenital heart disease, where myopenia is common ( 33 , 37 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

The “Super-Fontan” Phenotype: Characterizing Factors Associated With High Physical Performance

Tran

Celermajer

Ayer

et al. 2021

Front. Cardiovasc. Med.

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Background: People with a Fontan circulation usually have moderately impaired exercise performance, although a subset have high physical performance (“Super-Fontan”), which may represent a low-risk phenotype.Methods: People with a “Super-Fontan” phenotype were defined as achieving normal exercise performance [≥80% predicted peak oxygen uptake (VO2) and work rate] during cardiopulmonary exercise testing (CPET) and were identified from the Australian and New Zealand Fontan Registry. A Fontan control group that included people with impaired exercise performance (<80% predicted VO2 or work rate) was also identified based on a 1:3 allocation ratio. A subset of participants were prospectively recruited and completed a series of physical activity, exercise self-efficacy, and health-related quality of life questionnaires.Results: Sixty CPETs (“Super-Fontan”, n = 15; control, n = 45) were included. A subset (“Super-Fontan”, n = 10; control, n = 13) completed a series of questionnaires. Average age was 29 ± 8 years; 48% were males. Exercise capacity reflected by percent predicted VO2 was 67 ± 17% in the entire cohort. Compared to the “Super-Fontan” phenotype, age at Fontan completion was higher in controls (4.0 ± 2.9 vs. 7.2 ± 5.3 years, p = 0.002). Only one (7%) person in the “Super-Fontan” group had a dominant right ventricle compared to 15 (33%) controls (p = 0.043). None of those in the “Super-Fontan” group were obese, while almost a quarter (22%) of controls were obese based on body mass index (p = 0.046). Lung function abnormalities were less prevalent in the “Super-Fontan” group (20 vs. 70%, p = 0.006). Exercise self-efficacy was greater in the “Super-Fontan” group (34.2 ± 3.6 vs. 27.9 ± 7.2, p = 0.02). Self-reported sports participation and physical activity levels during childhood and early adulthood were higher in the “Super-Fontan” group (p < 0.05). The total average time spent participating in structured sports and physical activity was 4.3 ± 2.6 h/wk in the “Super-Fontan” group compared to 2.0 ± 3.0 h/wk in controls, p = 0.003. There were no differences in self-reported current total physical activity score or health-related quality of life between groups (p ≥ 0.05).Conclusions: The “Super-Fontan” phenotype is associated with a healthy weight, lower age at Fontan completion, better exercise self-efficacy, and higher overall levels of sport and physical activity participation during physical development.

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Section: Discussionmentioning

confidence: 99%

The “Super-Fontan” Phenotype: Characterizing Factors Associated With High Physical Performance

Tran

Celermajer

Ayer

et al. 2021

Front. Cardiovasc. Med.

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“…A study found that EAT was associated with right ventricular end-diastolic pressure (RVEDP) but not with left-sided filling pressures (pulmonary capillary wedge pressure and LV end-diastolic pressure) [ 68 ]. Another study found a modest correlation between EAT volume and pulmonary vascular resistance in Fontan patients [ 69 ].…”

Section: Section 1: Physiological and Anatomical Features Of Eatmentioning

confidence: 99%

Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue

Walpot,

Van Herck,

Van de Heyning

et al. 2023

ait

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Over the last two decades, the potential role of epicardial adipocyte tissue (EAT) as a marker for major adverse cardiovascular events has been extensively studied.Unlike other visceral adipocyte tissues (VAT), EAT is not separated from the adjacent myocardium by a fascial layer and shares the same microcirculation with the myocardium. Adipocytokines, secreted by EAT, interact directly with the myocardium through paracrine and vasocrine pathways. The role of the Randle cycle, linking VAT accumulation to insulin resistance, and the relevance of blood flow and mitochondrial function of VAT, are briefly discussed.The three available imaging modalities for the assessment of EAT are discussed. The advantages of echocardiography, cardiac CT, and cardiac magnetic resonance (CMR) are compared.The last section summarises the current stage of knowledge on EAT as a clinical marker for major adverse cardiovascular events (MACE). The association between EAT volume and coronary artery disease (CAD) has robustly been validated. There is growing evidence that EAT volume is associated with computed tomography coronary angiography (CTCA) assessed high-risk plaque features. The EAT CT attenuation coefficient predicts coronary events. Many studies have established EAT volume as a predictor of atrial fibrillation after cardiac surgery. Moreover, EAT thickness has been independently associated with severe aortic stenosis and mitral annular calcification. Studies have demonstrated that EAT volume is associated with heart failure. Finally, we discuss the potential role of EAT in critically ill patients admitted to the intensive care unit.In conclusion, EAT seems to be a promising new biomarker to predict MACE.

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