Hostname: page-component-7c8c6479df-8mjnm Total loading time: 0 Render date: 2024-03-19T02:14:57.168Z Has data issue: false hasContentIssue false

Exercise restriction is not associated with increasing body mass index over time in patients with anomalous aortic origin of the coronary arteries

Published online by Cambridge University Press:  02 May 2017

James M. Meza
Affiliation:
John W. Kirklin/David Ashburn Fellow, Congenital Heart Surgeons’ Society Data Center, Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
Matthew D. Elias
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Travis J. Wilder
Affiliation:
Department of Surgery, University of California San Diego School of Medicine, San Diego, California, United States of America
James E. O’Brien
Affiliation:
Division of Cardiovascular Surgery, Children’s Mercy Hospital, Kansas City, Missouri, United States of America
Richard W. Kim
Affiliation:
Division of Cardiothoracic Surgery, Children’s Hospital of Los Angeles, Los Angeles, California, United States of America
Constantine Mavroudis
Affiliation:
Department of Congenital Heart Surgery, Florida Hospital for Children, Orlando, Florida, United States of America
William G. Williams
Affiliation:
Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, CA
Julie Brothers
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Meryl S. Cohen
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Brian W. McCrindle*
Affiliation:
Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
*
Correspondence to: B. W. McCrindle, MD, MPH, Division of Cardiology, The Hospital for Sick Children, 555 University Avenue, Room 4432, Toronto, ON, Canada, M5G 1X8. Tel: +1 416 813 7609; Fax: +1 416 813 7547; E-mail: brian.mccrindle@sickkids.ca

Abstract

Anomalous aortic origin of the coronary arteries is associated with exercise-induced ischaemia, leading some physicians to restrict exercise in patients with this condition. We sought to determine whether exercise restriction was associated with increasing body mass index over time. From 1998 to 2015, 440 patients ⩽30 years old were enrolled into an inception cohort. Exercise-restriction status was documented in 143 patients. Using linear mixed model repeated-measures regression, factors associated with increasing body mass index z-score over time, including exercise restriction and surgical intervention as time-varying covariates, were investigated. The 143 patients attended 558 clinic visits for which exercise-restriction status was recorded. The mean number of clinic visits per patient was 4, and the median duration of follow-up was 1.7 years (interquartile range (IQR) 0.5–4.4). The median age at first clinic visit was 10.3 years (IQR 7.1–13.9), and 71% (101/143) were males. All patients were alive at their most recent follow-up. At the first clinic visit, 54% (78/143) were exercise restricted, and restriction status changed in 34% (48/143) during follow-up. The median baseline body mass index z-score was 0.2 (IQR 0.3–0.9). In repeated-measures analysis, neither time-related exercise restriction nor its interaction with time was associated with increasing body mass index z-score. Surgical intervention and its interaction with time were associated with decreasing body mass index z-score. Although exercise restriction was not associated with increasing body mass index over time, surgical intervention was associated with decreasing body mass index z-score over time in patients with anomalous aortic origin of the coronary arteries.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

James M. Meza, Matthew Elias, Brian W. McCrindle, and Meryl Cohen contributed equally to this manuscript.

References

1. Frescura, C, Basso, C, Thiene, G, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998; 29: 689695.Google Scholar
2. Basso, C, Maron, BJ, Corrado, D, Thiene, G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 14931501.Google Scholar
3. Maron, BJ, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007; 115: 1643–1455.Google Scholar
4. Brothers, J, Carter, C, McBride, M, Spray, T, Paridon, S. Anomalous left coronary artery origin from the opposite sinus of Valsalva: evidence of intermittent ischemia. J Thorac Cardiovasc Surg 2010; 140: e27e29.Google Scholar
5. Brothers, J, Gaynor, JW, Paridon, S, Lorber, R, Jacobs, M. Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults. Pediatr Cardiol 2009; 30: 911921.Google Scholar
6. Van Hare, GF, Ackerman, MJ, Evangelista, J-aK, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015; 66: 23722384.Google Scholar
7. Pinto, NM, Marino, BS, Wernovsky, G, et al. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120: e1157e1164.Google Scholar
8. Shustak, RJ, McGuire, SB, October, TW, Phoon, CK, Chun, AJ. Prevalence of obesity among patients with congenital and acquired heart disease. Pediatr Cardiol 2012; 33: 814.Google Scholar
9. Lamotte, C, Iliescu, C, Libersa, C, Gottrand, F. Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies. Eur J Pediatr 2011; 170: 719729.Google Scholar
10. Woo, KS, Chook, P, Yu, CW, et al. Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening. Int Obes Relat Metab Disord 2004; 28: 852857.Google Scholar
11. Brothers, JA, Gaynor, JW, Jacobs, JP, et al. The registry of anomalous aortic origin of the coronary artery of the Congenital Heart Surgeons’ Society. Cardiol Young 2010; 20 (Suppl 3): 5058.Google Scholar
12. Poynter, JA, Williams, WG, McIntyre, S, Brothers, JA, Jacobs, ML, Congenital Heart Surgeons Society AWG. Anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons Society Registry. World J Pediatr Congenit Heart Surg 2014; 5: 2230.Google Scholar
13. Kuczmarski, RJ, Ogden, CL, Guo, SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11 2002; 246: 1190.Google Scholar
14. Poynter, JA, Bondarenko, I, Austin, EH, et al. Repair of anomalous aortic origin of a coronary artery in 113 patients: a Congenital Heart Surgeons’ Society report. World J Pediatr Congenit Heart Surg 2014; 5: 507514.Google Scholar
15. Arvidsson, D, Slinde, F, Hulthen, L, Sunnegardh, J. Physical activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects. Acta Paediatr 2009; 98: 14751482.Google Scholar
16. Massin, MM, Hovels-Gurich, HH, Gerard, P, Seghaye, MC. Physical activity patterns of children after neonatal arterial switch operation. Ann Thorac Surg 2006; 81: 665670.CrossRefGoogle ScholarPubMed
17. McCrindle, BW, Williams, RV, Mital, S, et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509514.Google Scholar
18. Brown, DW, Dipilato, AE, Chong, EC, et al. Sudden unexpected death after balloon valvuloplasty for congenital aortic stenosis. J Am Coll Cardiol 2010; 56: 19391946.Google Scholar
19. Rome, JJ. Exercise restriction to prevent sudden death in congenital aortic stenosis: whom are we treating? J Am Coll Cardiol 2010; 56: 19471948.Google Scholar
20. Stefan, MA, Hopman, WM, Smythe, JF. Effect of activity restriction owing to heart disease on obesity. Arch Pediatr Adolesc Med 2005; 159: 477481.Google Scholar
21. Centers for Disease Control and Prevention, Brener, ND, Kahn, L, Shanklin, S, et al. Methodology of the Youth Risk Behavior Surveillance System–2013; United States Centers for Disease Control and Prevention. MMWR 2013; 62: 1–20.Google Scholar
22. Centers for Disease Control and Prevention. The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services; 2010.Google Scholar
23. Dean, PN, Gillespie, CW, Greene, EA, et al. Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenit Heart Dis 2015; 10: 169179.Google Scholar
24. Cheuk, DK, Wong, SM, Choi, YP, Chau, AK, Cheung, YF. Parents’ understanding of their child’s congenital heart disease. Heart 2004; 90: 435439.Google Scholar
25. Lentzner, BJ, Connolly, DM, Phoon, CK. Do paediatric cardiologists discuss cardiovascular risk factors with patients and their families? Cardiol Young 2003; 13: 551558.Google Scholar
26. Swan, L, Hillis, WS. Exercise prescription in adults with congenital heart disease: a long way to go. Heart 2000; 83: 685687.Google Scholar
27. Longmuir, PE, McCrindle, BW. Physical activity restrictions for children after the Fontan operation: disagreement between parent, cardiologist, and medical record reports. Am Heart J 2009; 157: 853859.Google Scholar