Effect of obesity on cardiovascular remodeling, and aerobic capacity in adults with coarctation of aorta

Ahmed E Ali; Ahmed T Abdelhalim; William R Miranda; Sara ElZalabany; Amr Moustafa; Ali Ali; Heidi M Connolly; Alexander C Egbe

doi:10.1016/j.ijcard.2025.132970

Effect of obesity on cardiovascular remodeling, and aerobic capacity in adults with coarctation of aorta

Int J Cardiol. 2025 Jan 9:422:132970. doi: 10.1016/j.ijcard.2025.132970. Online ahead of print.

Authors

Ahmed E Ali¹, Ahmed T Abdelhalim¹, William R Miranda¹, Sara ElZalabany¹, Amr Moustafa¹, Ali Ali¹, Heidi M Connolly¹, Alexander C Egbe²

Affiliations

¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America. Electronic address: egbe.alexander@mayo.edu.

PMID: 39793761
DOI: 10.1016/j.ijcard.2025.132970

Abstract

Background: We hypothesized that patients with coarctation of aorta (COA) and obesity would have more advanced cardiovascular remodeling and impaired aerobic capacity compared to COA patients without obesity. The purpose of this study was to assess the relationship between obesity, cardiovascular remodeling, and aerobic capacity in adults with repaired COA.

Method: The study comprised of 3 groups: (1) Obese COA group (n=177) (COA patients with body mass index [BMI] >30 kg/m²); (2) Non-obese COA group (n=572) (COA patients with BMI ≤30 kg/m²); (3) Control group (n=59) (subjects without structural heart disease and BMI ≤30 kg/m²). Cardiovascular remodeling was assessed using the following indices: (1) Arterial stiffness - total arterial compliance index (TACI). (2) Left ventricular hypertrophy - LV mass (LVM) and relative wall thickness (RWT). (3) LV diastolic function - Doppler-derived estimated LV end-diastolic pressure (LVEDP) and Tau. (4) Right ventricular (RV)-pulmonary artery coupling - RV free wall strain and RV systolic pressure (RVFW/RVSP). Aerobic capacity was assessed using predicted peak oxygen consumption (VO₂).

Results: The obese COA group had higher LVM, RWT, LVEDP, and Tau, as well as lower RVFWS/RVSP, TACI and peak VO₂ compared to non-obese COA group and controls. There was a correlation between BMI and LVM (r = 0.39, p < 0.001), RWT (r = 0.47, p < 0.001), LVEDP (r = 0.43, p < 0.001), tau (r = 0.22, p = 0.008), RVFWS/RVSP (r = - 0.24, p < 0.001), and predicted peak VO₂ (r = -0.48, p < 0.001).

Conclusions: These findings underscore the cardiovascular implications of obesity in the setting of COA, and provide opportunities for interventions to address obesity, and improve outcomes in this population.

Keywords: Cardiovascular remodeling; Exercise capacity; Obesity.