Insulin Resistance after Fontan Palliation

Area of Science:

• Cardiology
• Metabolic Health
• Pediatric Health

Background:

• Patients with single ventricle heart physiology post-Fontan palliation (S/P Fontan) face elevated risks of acquired morbidity.
• Insulin resistance (IR) is a known predictor of cardiac morbidity and mortality in various populations.

Purpose of the Study:

• To assess and compare insulin resistance (IR) in patients S/P Fontan versus healthy controls.
• To investigate the association between age and IR in the S/P Fontan cohort.

Main Methods:

• A single-center, cross-sectional study included 59 S/P Fontan patients and 30 controls.
• Insulin resistance was evaluated using the Quantitative Insulin Index (QUICKI) and ln (HOMA-IR).
• Analyses were performed with and without adjustment for age, and also excluded patients with obesity.

Main Results:

• S/P Fontan patients exhibited significantly lower QUICKI and higher ln (HOMA-IR) compared to controls (p < 0.0001), even after age adjustment.
• IR prevalence was substantially higher in S/P Fontan patients (69.5% by QUICKI, 54.2% by HOMA-IR) versus controls (10% and 16.7%, respectively).
• A significant, progressive increase in IR was observed with advancing age in the S/P Fontan group.

Conclusions:

• Patients S/P Fontan demonstrate significantly higher insulin resistance compared to controls.
• The prevalence of IR increases with age in the S/P Fontan population.
• Early identification and management of IR in S/P Fontan patients are crucial due to its association with long-term morbidity and mortality.