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<p>Cardiopulmonary exercise testing (CPET) is a valuable prognostic tool in patients with Fontan physiology, yet the impact of social determinants of health – such as the Childhood Opportunity Index (COI) – on exercise capacity (VO2/kg) remains unclear. We evaluate the relationship between COI and predicted VO2/kg in a pediatric Fontan cohort. We performed a retrospective review of 158 Fontan patients who completed a clinically indicated CPET. CPET parameters were expressed as a percent of predicted value using standardized equations. COI quintile (1 = lowest opportunity, 5 = highest) was assigned based on home address (diversitydatakids.org). The association between COI and VO<sub>2</sub>/kg was assessed using a Spearman rank correlation(ρ). Group comparisons were performed for lower performers (VO<sub>2</sub>/kg &lt; 60% predicted) vs. higher performers (VO<sub>2</sub>/kg ≥ 60% predicted). Patients in COI groups were compared using univariate and multivariate analysis to explore the independent predictors of exercise capacity. Patients in higher opportunity groups (COI 4–5, <i>n</i> = 51) had higher VO<sub>2</sub>/kg compared to the lowest opportunity group (COI 1, <i>n</i> = 54) (57.7 ± 2.0 vs. 51.5 ± 1.5, <i>p</i> = 0.01). Across COI quintiles, there was an association with VO<sub>2</sub>/kg (Spearman ρ = 0.191, <i>p</i> = 0.016; bootstrap 95% CI 0.041–0.335). Lower performers (VO<sub>2</sub>/kg &lt; 60% predicted) were older (14.7 vs. 13.0 years, p = &lt; 0.001) and had higher BMI (22.4 vs. 17.8, <i>p</i> &lt; 0.001). BMI had a inverse relationship with COI (Spearman ρ=−0.319, <i>p</i> &lt; 0.001; bootstrap 95% CI − 0.45 to − 0.18). In multivariate analysis BMI &gt; 20 (OR 6.5; 2.1–19.7) along with systemic right ventricle morphology (OR = 1.8, 1.1–2.9) were both independent predictors of low VO<sub>2</sub>/kg. In this single center cohort of 158 patients with Fontan physiology, higher BMI and systemic right ventricular morphology both independently predicted lower VO<sub>2</sub>/kg. Lower neighborhood opportunity, as measured by lower COI, was associated with reduced VO<sub>2</sub>/kg and higher BMI but was not an independent predictor after adjustment, suggesting an indirect effect of SDOH on VO<sub>2</sub>/kg possibly through BMI.</p>

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High BMI Associated with Lower Child Opportunity Index Negatively Impacts Exercise Capacity in Fontan Patients

  • 期刊论文

  • 发表日期：

    2026年1月31日

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  • Zachery Thompson,
  • Deepti P Bhat,
  • Sophia Williams,
  • Arash Sabati

摘要

Cardiopulmonary exercise testing (CPET) is a valuable prognostic tool in patients with Fontan physiology, yet the impact of social determinants of health – such as the Childhood Opportunity Index (COI) – on exercise capacity (VO2/kg) remains unclear. We evaluate the relationship between COI and predicted VO2/kg in a pediatric Fontan cohort. We performed a retrospective review of 158 Fontan patients who completed a clinically indicated CPET. CPET parameters were expressed as a percent of predicted value using standardized equations. COI quintile (1 = lowest opportunity, 5 = highest) was assigned based on home address (diversitydatakids.org). The association between COI and VO2/kg was assessed using a Spearman rank correlation(ρ). Group comparisons were performed for lower performers (VO2/kg < 60% predicted) vs. higher performers (VO2/kg ≥ 60% predicted). Patients in COI groups were compared using univariate and multivariate analysis to explore the independent predictors of exercise capacity. Patients in higher opportunity groups (COI 4–5, n = 51) had higher VO2/kg compared to the lowest opportunity group (COI 1, n = 54) (57.7 ± 2.0 vs. 51.5 ± 1.5, p = 0.01). Across COI quintiles, there was an association with VO2/kg (Spearman ρ = 0.191, p = 0.016; bootstrap 95% CI 0.041–0.335). Lower performers (VO2/kg < 60% predicted) were older (14.7 vs. 13.0 years, p = < 0.001) and had higher BMI (22.4 vs. 17.8, p < 0.001). BMI had a inverse relationship with COI (Spearman ρ=−0.319, p < 0.001; bootstrap 95% CI − 0.45 to − 0.18). In multivariate analysis BMI > 20 (OR 6.5; 2.1–19.7) along with systemic right ventricle morphology (OR = 1.8, 1.1–2.9) were both independent predictors of low VO2/kg. In this single center cohort of 158 patients with Fontan physiology, higher BMI and systemic right ventricular morphology both independently predicted lower VO2/kg. Lower neighborhood opportunity, as measured by lower COI, was associated with reduced VO2/kg and higher BMI but was not an independent predictor after adjustment, suggesting an indirect effect of SDOH on VO2/kg possibly through BMI.