Related Experiment Video
Updated: Jul 5, 2025
Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model
Published on: June 9, 2023
Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population
Nitin Madan1,2, Doaa Aly1,2, Melanie Kathol1
1Ward Family Heart Center, Children's Mercy Kansas City Kansas City MO USA.
Insights
Obesity negatively impacts heart muscle function in young Fontan patients, particularly those with a single right ventricle. This study highlights the adverse relationship between elevated body mass index (BMI) and myocardial strain.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Obesity is linked to reduced myocardial function in pediatric populations with normal heart anatomy.
- Limited data exists on obesity's impact on myocardial strain in single-ventricle patients.
- The Fontan population presents a unique context for studying obesity's cardiovascular effects.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) and myocardial strain in children and young adults with a single ventricle (Fontan circulation).
- To assess how abnormal BMI (overweight and obesity) affects ventricular strain parameters in this specific patient group.
Main Methods:
- A case-control study comparing 38 Fontan patients with abnormal BMI (overweight/obese) to 30 controls with normal BMI, matched for ventricular morphology, age, and sex.
- Echocardiography was used to measure single ventricle global longitudinal peak systolic strain (GLS) and other parameters.
- Statistical analysis, with P≤0.05 considered significant, was performed to compare groups.
Main Results:
- Fontan patients with abnormal BMI exhibited significantly diminished GLS (-15.7±3.6%) compared to normal BMI controls (-17.2±3.2%, P=0.03).
- Elevated systolic blood pressure was noted in the abnormal BMI group (P=0.04).
- Subgroup analysis revealed diminished GLS in abnormal BMI patients with a single right ventricle, but not in those with a single left ventricle or biventricular morphology.
Conclusions:
- Obesity adversely affects myocardial strain in the young Fontan population.
- The single right ventricle morphology shows the most compromised myocardial strain response to abnormal BMI in this cohort.
- These findings underscore the importance of weight management in single-ventricle physiology.
Background:
Obesity is associated with diminished myocardial function as measured by strain echocardiography in children and young adults with normal cardiac anatomy. Data are lacking about the effect of obesity on myocardial strain in patients with a single ventricle. In this study, the relationship between body mass index (BMI) and single ventricle myocardial strain in the Fontan population was assessed.
Methods And Results:
Thirty-eight abnormal BMI Fontan cases (21 overweight and 17 obese) and 30 normal BMI Fontan controls matched based on single ventricular morphology, age, and sex were included in the study. Ventricular morphology was categorized as single right ventricle, single left ventricle, or biventricular. Single ventricle global longitudinal peak systolic strain (GLS) and other echocardiographic measurements were performed and compared between groups, with a P≤0.05 defined as significant. The abnormal BMI group demonstrated diminished GLS (-15.7±3.6% versus -17.2±3.2%, [P=0.03]) and elevated systolic blood pressure (P=0.04) compared with the normal BMI group. On subgroup analysis of those with single right ventricle morphology, the abnormal BMI group demonstrated diminished GLS compared with controls. There was no significant difference in GLS between the abnormal BMI and control groups in the single left ventricle and biventricular subgroups. Analyzed by ventricular morphology, no other variables were statistically different in the abnormal BMI group including systolic blood pressure. Inter-reader reproducibility for GLS and strain rate were excellent for both measures.
Conclusions:
Obesity has an adverse relationship with myocardial strain in the young Fontan population, with the most maladaptive response seen in the single right ventricle.
