Abstract 18774: Increased Epicardial Fat After Fontan Palliation Associated With Decreased Cardiac Output
Introduction: Epicardial fat produces multiple proinflammatory and proatherogenic cytokines and is associated with adverse cardiovascular events. Inflammation and resultant endothelial dysfunction may play a role in progressive myocardial dysfunction among adults with single ventricle physiology status post Fontan, but the potential impact of epicardial fat volume (EFV) has not been studied. This study aimed to quantify EFV in Fontan patients compared to a control group of repaired tetralogy of Fallot patients (rTOF) and to evaluate its association with ventricular ejection fraction and cardiac index.
Methods: We retrospectively measured EFV on all patients post Fontan, 15 years or older, with cardiac magnetic resonance performed at the University of Michigan from 2007-2014, and 1:1 age, sex, and body mass index (BMI) matched patients with rTOF. EFV was measured manually on cine, steady-state free precession, short-axis images and was indexed to body surface area (BSA). Cardiac index was calculated as the sum of flow in the superior vena cava and inferior vena cava, indexed to BSA. A random subset of studies was re-measured >1 week after initial measurement to assess intraobserver variability.
Results: Fontan patients (n=63, mean age 22.3±6.0, 52% male) had a larger indexed EFV compared to rTOF (mean age 22.2±5.8, 52% male) measuring 75.6±29.2 vs. 60.0±19.9 ml/m2 (p= 0.0003). There was no difference in BMI between the two groups (24.2±5.2 vs 24.2±5.6, p= 0.81). In Fontan patients, indexed EFV was inversely correlated with ventricular ejection fraction (r = -0.26, p = 0.03) and cardiac index (r = -0.34, p = 0.01). Intraobserver variability of the indexed EFV measurements in both groups was excellent (intraclass correlation coefficient of 0.95 and 0.93 in the Fontan group and rTOF group, respectively).
Conclusions: Indexed EFV is higher in individuals post Fontan compared to patients with rTOF and is associated with lower ventricular ejection fraction and cardiac index. Increased epicardial fat could play a role in progressive myocardial dysfunction in this population, but longitudinal studies are necessary to establish any causative role.
Author Disclosures: A.M. Lubert: None. J.C. Lu: None. A.P. Rocchini: None. M.D. Norris: None. S. Yu: None. P.P. Agarwal: None. M. Ghadimi Mahani: None. A.L. Dorfman: None.
- © 2015 by American Heart Association, Inc.