PMID- 26365670
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20161230
IS  - 1747-0803 (Electronic)
IS  - 1747-079X (Linking)
VI  - 11
IP  - 1
DP  - 2016 Jan-Feb
TI  - Increased Body Mass Index Is Associated with Congestive Heart Failure and 
      Mortality in Adult Fontan Patients.
PG  - 71-9
LID - 10.1111/chd.12296 [doi]
AB  - OBJECTIVE: Obesity affects adults with congenital heart disease (CHD). The effect 
      of an increased body mass index (BMI) with respect to morbidity and mortality has 
      not been evaluated in adults with complex CHD. Our objective was to evaluate the 
      effects of increased BMI on heart failure and mortality in univentricular 
      patients who had undergone Fontan palliation. METHODS: A query of Fontan 
      patients' first appointments at the Washington University Center for Adults with 
      CHD between 2007 and 2014 yielded 79 patients. BMI status as normal (<25 kg/m(2) 
      ), overweight (>/=25, <30 kg/m(2) ), and obese (>/=30 kg/m(2) ) was established at 
      the patient's first appointment. We analyzed demographics, diuretic requirements, 
      New York Heart Association (NYHA) class, and laboratory values using Student's 
      two-sample t-test and Fisher's exact test. Mortality was assessed via survival 
      curves, and hazard ratios were compiled with proportional hazard modeling. 
      RESULTS: The recent average BMI was significantly greater in patients with NYHA 
      classes II-IV (29.3 +/- 9 kg/m(2) ) compared with asymptomatic patients (24.8 +/- 
      5.1 kg/m(2) , P = .006). Additionally, the average BMI of patients with a high 
      diuretic requirement (>/=40 mg/day IV furosemide equivalent) was obese, at 32.15 +/- 
      9.1 kg/m(2) , compared with 25.91 +/- 7.3 kg/m(2) for those on no or lower doses of 
      diuretics (P = .009). Eighteen of the 79 patients met an endpoint of death, 
      hospice placement, or cardiac transplant by the study conclusion. Kaplan-Meier 
      analysis from time of first appointment until recent follow-up revealed a 
      significant association between time to combined endpoint and BMI class. Cox 
      proportional hazard modeling with age adjustment yielded a hazard ratio of 3.2 
      (95% CI 1.096-9.379) for obesity upon first presentation to an adult CHD clinic. 
      CONCLUSIONS: In patients with univentricular hearts and Fontan palliation, 
      obesity is associated with symptomatic heart failure and mortality.
CI  - (c) 2015 Wiley Periodicals, Inc.
FAU - Martinez, Sara C
AU  - Martinez SC
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Byku, Mirnela
AU  - Byku M
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Novak, Eric L
AU  - Novak EL
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Cedars, Ari M
AU  - Cedars AM
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Eghtesady, Pirooz
AU  - Eghtesady P
AD  - Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington 
      University School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Ludbrook, Philip A
AU  - Ludbrook PA
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
FAU - Billadello, Joseph J
AU  - Billadello JJ
AD  - Cardiovascular Division, Department of Internal Medicine, Washington University 
      School of Medicine in St. Louis, St. Louis, Mo, USA.
LA  - eng
GR  - T32HL007081/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20150914
PL  - United States
TA  - Congenit Heart Dis
JT  - Congenital heart disease
JID - 101256510
RN  - 0 (Diuretics)
SB  - IM
MH  - Adult
MH  - *Body Mass Index
MH  - Databases, Factual
MH  - Diuretics/therapeutic use
MH  - Female
MH  - Fontan Procedure/*adverse effects/mortality
MH  - Heart Defects, Congenital/diagnosis/mortality/*surgery
MH  - Heart Failure/diagnosis/drug therapy/*etiology/mortality
MH  - Heart Transplantation
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Missouri
MH  - Obesity/*complications/diagnosis/mortality
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Congestive Heart Failure
OT  - Diuretic Requirement
OT  - Fontan
OT  - Mortality
OT  - Obesity
EDAT- 2015/09/15 06:00
MHDA- 2016/12/15 06:00
CRDT- 2015/09/15 06:00
PHST- 2015/07/31 00:00 [accepted]
PHST- 2015/09/15 06:00 [entrez]
PHST- 2015/09/15 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - 10.1111/chd.12296 [doi]
PST - ppublish
SO  - Congenit Heart Dis. 2016 Jan-Feb;11(1):71-9. doi: 10.1111/chd.12296. Epub 2015 
      Sep 14.