- Poster presentation
- Open Access
Obesity leads to underestimation of ventricular volumes and abnormal myocardial strain in repaired Tetralogy of Fallot as measured by cardiac MRI
© Simpson et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Obese Patient
- Right Ventricular
- Congenital Heart Disease
- Right Ventricular Ejection Fraction
- Pulmonary Valve Replacement
Obesity is an increasing epidemic that has not spared children and adults with congenital heart disease. Patients with repaired tetralogy of Fallot with trans-annular patch (rTOF-TAP) have significant pulmonary insufficiency and right ventricular (RV) enlargement. Recommendations for pulmonary valve replacement (PVR) include body surface area (BSA)-indexed RV end diastolic volume (RVEDVi) >150 ml/m2 or indexed RV end systolic volume (RVESVi) >80 ml/m2, estimated by cardiac MRI (CMR). We hypothesized that: 1) overweight and obese patients with rTOF-TAP have underestimated indexed ventricular volumes when compared to volumes indexed to ideal BSA and 2) these patients have altered parameters of cardiac function compared to weight appropriate patients.
Retrospective review of 86 patients from 2009-2013 with rTOF-TAP who underwent CMR. Mean age 20.1 years (± 10.9). Patients assigned weight categories by Center for Disease Control guidelines for children and adults based on body mass index (BMI): appropriate weight (n = 51), overweight (n = 23), and obese (n = 12). CMR analysis included: 1) RV volumes and RV ejection fraction (RVEF); 2) Left ventricular (LV) volumes and LVEF; 3) Peak circumferential LV strain (εcc) using HARP analysis of myocardial tagged images. Overweight and obese patients assigned ideal BSAs to recalculate indexed RV volumes. Mann-Whitney U was used to compare continuous variables between groups.
Increased BMI leads to the underestimation of indexed RV volumes, possibly affecting timing of PVR. This underestimation should be corrected using ideal BSA. Decreased LV εcc has not been previously reported in obese patients with rTOF-TAP. Although clinical implications of abnormal εcc are unclear, these patients may be at higher risk for early LV dysfunction. Further studies on εcc in this patient population are recommended.
Funded in part by NIH T32HL 105334.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.