Abstract

Background The majority of children with congenital heart disease (CHD) survive into adulthood, and acquired cardiovascular risk factors, such as hypertension and obesity, are increasing considerations for adults with congenital heart disease (ACHD). Hypertension and obesity are associated with the development of left ventricle hypertrophy (LVH) in the general population. This study aims to evaluate the impact of obesity and blood pressure on LVH in the ACHD population.

Methods We retrospectively analyzed echocardiograms from subjects with biventricular CHD aged >18 years from 2012-2019. CHD lesion types were grouped according to the original embryologic pre-repaired form. We defined LVH using indexed cutoff values of ≥ 51 g/Ht2.7, and >115 g/m2 for males and >95 g/m2 for females. Patients were grouped by blood pressure (BP) into normotensive (NT, systolic BP (SBP) < 120 mm Hg), Elevated BP (E-BP, 120 ≥ SBP < 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≥ SBP < 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Obesity was defined as underweight (BMI <18.5), healthy weight (BMI 18.5≤ - <25), overweight (BMI 25≤ - 30), and obese (BMI ≥30).

Results There were 1,152 subjects included. Median age was 24 years (IQR 20, 32), with 50% females, median SBP of 121 mmHg, and median LVM of 36 g/ Ht2.7 and 78 g/m2. There were 519/1152 (45%) in the NT group, 313/1152 (27%) E-BP, 183/1152 (15.8%) HTN-1, and 137/1152 (12%) HTN-2. When evaluating BMI, a model adjusting for confounders of age, sex, and cardiac diagnosis, demonstrated that a 10-unit increase of BMI was associated with an increase in LVM indexed by BSA of 1.27 g/m2 (95% CI: −0.38, 2.93; p = 0.13), and 7.95 g/m2.7 (95% CI: 7.13, 8.77; p < 0.001) when indexed to LVH-Ht2.7. BMI was strongly associated with increased in LVH-Ht2.7, as having knowledge of an individual’s BMI showed a 21% increase in explained variation.

Conclusions Obesity demonstrated the highest level of correlation on the development of LVH in this ACHD population, as it demonstrated a 21% increase in explained variation. This finding highlights the need for early prevention and weight loss interventions in the ACHD population.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

No forms of payment or services from a third party were involved in this study. No form of grant funding was used for study design or manuscript preparation.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This project was reviewed and approved by the institutional IRB at Nationwide Children's Hospital.

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Data Availability

All data referred to in this manuscript is accessible upon request.

AbbreviationsACHDAdult Congenital Heart DiseaseCHDCongenital Heart DiseaseLVMI-ht2.7Left ventricular mass indexed to patient height to the power of 2.7LVMiLeft ventricular mass indexed to patient body surface areaNTNormotensiveE-BPElevated blood pressureHTN-1Stage 1 hypertensionHTN-2Stage 2 hypertensionSBPsystolic blood pressureLVOTLeft ventricular outflow tractLVSFLeft ventricular shortening fractionTOFTetralogy of FallotTATruncus arteriosus