Systemic ventricular strain is abnormal with elevated BMI in adults with congenital heart disease

Background: Obesity is associated with left ventricular (LV) hypertrophy and cardiac dysfunction. In obese adults with congenital heart disease (ACHD), a sensitive echocardiographic marker like strain might enable early detection of subclinical cardiac changes. Objectives: To assess the association of elevated body mass index (BMI) with global longitudinal (GLS) and circumferential strain (GCS) in ACHD. Methods: 2D transthoracic echocardiograms (TTE) done on 267 ACHD patients (excluding those with genetic syndromes and single ventricle) in 2016 were analyzed. Echocardiographic images were analyzed offline using TomTec Image Arena to obtain global longitudinal (GLS) and circumferential strain (GCS). Data were analyzed with SAS software using Chi-square and Wilcoxon Rank-Sum tests. Results: Univariate analysis shows a significant association of elevated BMI with median GCS (p = 0.01), median GLS (p = 0.01), and hypertension (p = 0.03). Multivariate logistic regression shows a significant association of elevated BMI with GLS (p = 0.01; CI, 1.02–1.25), and GCS (p = 0.02; CI, 1.01–1.23) after adjusting for hypertension, ejection fraction (EF), LV end diastolic volume and type of CHD. There is no association between elevated BMI and gender, LV mass, EF, and type of CHD. Conclusions: 2D TTE derived longitudinal and circumferential strain is abnormal in ACHD patients with elevated BMI. This may help identify a subset of patients with subclinical myocardial dysfunction as a target for lifestyle modification to prevent progression to cardiac dysfunction.