The association between pulmonary arterial hypertension and malnutrition in children who had acyanotic congenital heart diseases with left to right shunt: an observational study

Abstract

Sol-sağ şantlı doğuştan kalp hastalığı olan çocuklarda pulmoner arteriyel hipertansiyonla malnütrisyonun ilişkisi: Gözlemsel bir çalışmaThe association between pulmonary arterial hypertension and malnutrition in children with congenital heart diseases with left-to-right shunt: an observational study Özgün Araşt›rma Original Investigation ABSTRACTObjective: To evaluate the association between the degree of pulmonary arterial hypertension (PAH) and the level of malnutrition in children with acyanotic congenital heart diseases and left-to-right shunt, and especially to evaluate the development rates of malnutrition in patients with borderline PAH. Methods:The study was performed with data of 327 patients with acyanotic congenital heart diseases and left-to-right shunt and underwent cardiac catheterization between January 2001-February 2011. The design of the study was retrospective and observational. All patients were evaluated with anthropometric measurements, echocardiography and cardiac catheterization. They were classified according to the mean pulmonary artery pressure and level of malnutrition. Chi-square, ANOVA and Kruskal-Wallis tests were used for statistical analysis. Normally and abnormally distributed data were analyzed with Pearson and Spearman correlation tests respectively. Results: Malnutrition was detected in 94.8% of patients with PAH and 17.2% of no PAH patients according to Gomez classification (p<0.001). In addition, malnutrition was detected in 23.5% (16/68) of borderline PAH group. A negative association was detected between mean pulmonary arterial pressure and body weight for age (Gomez) and z scores of weight (p<0.001 for all). Z scores of weight and height were significantly decreased in patients with PAH in contrast to no PAH group (p<0.001, p<0.01 respectively). There was no statistical difference between no PAH and borderline PAH groups according to Gomez classification and relative body weight formula, however z scores of weight in borderline PAH group were decreased compared with no PAH group (p<0.001). . Sınırda PAH'ı olanların ise %23.5'inde (16/68) malnütrisyon tespit edildi. Ortalama pulmoner arter basıncı ile yaşa göre vücut ağırlığı (Gomez) ve kilo z skorları arasında negatif ilişki mevcuttu (her ikisi için p<0.001). Kilo ve boy z skorları da PAH olanlarda olmayanlara göre belirgin düşüktü (sırasıyla p<0.001, p<0.01). Gomez sınıflaması ve rölatif vücut ağırlığına göre PAH olmayan ve sınırda PAH olan gruplar arasında fark yoktu, ancak sınırda PAH grubunun kilo z skorları PAH olmayan gruba göre düşüktü (p<0.001). Sonuç: Asiyanotik sol-sağ şantlı DKH'lı çocuklarda PAB arttıkça, beraberinde malnütrisyon derecesinin de ağırlaştığı görüldü. Sınırda PAH'ı olan hastaların olmayanlara göre malnütrisyona daha fazla eğilimli olduğu izlendi, ancak bu konuda daha geniş kapsamlı araştırmaların yapılması gerektiği düşünüldü. (Anadolu Kardiyol Derg 2012; 12: 150-9) Anahtar kelimeler: Çocuk, malnütrisyon, doğuştan kalp hastalığı, pulmoner arteriyel hipertansiyon