Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome

Area of Science:

• Pediatric Cardiology
• Growth and Development
• Cardiovascular Health

Background:

• Fontan operation survivors often exhibit abnormal height and adiposity.
• These anthropometric deviations may negatively impact functional outcomes.
• Understanding these associations is crucial for long-term Fontan patient care.

Purpose of the Study:

• To investigate the relationship between anthropometric measures (height and body mass index) and functional health status in Fontan survivors.
• To identify associations between abnormal growth and adiposity with clinical testing results.
• To inform clinical management and improve long-term outcomes for this vulnerable population.

Main Methods:

• Analysis of cross-sectional data from 544 Fontan patients.
• Patients categorized by height-z score (<-1.5 or ≥-1.5) and BMI-z score (<-1.5, -1.5 to 1.5, or ≥1.5).
• Associations examined with exercise, echocardiography, MRI, and Child Health Questionnaire data, adjusting for covariates.

Main Results:

• 23% of patients had shorter stature (height-z <-1.5), associated with pre-Fontan atrioventricular valve regurgitation and developmental problems.
• Shorter stature correlated with lower physical and psychosocial functional health status scores.
• Higher BMI-z was linked to increased ventricular mass-to-volume ratio and reduced exercise capacity, despite similar functional health status scores compared to normal BMI.

Conclusions:

• Abnormal anthropometry, including short stature and altered adiposity, is prevalent in Fontan survivors.
• Shorter stature is a marker for poorer functional health and co-existing non-cardiac conditions.
• Increased adiposity is associated with adverse cardiac remodeling and impaired exercise performance, highlighting significant long-term implications.