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Background Greater body mass index is associated with cardiovascular remodeling in adolescents. However, body mass index cannot differentiate between adipose and nonadipose tissues. We examined how visceral and subcutaneous adipose tissue are linked with markers of early cardiovascular remodeling, independently from nonadipose tissue. Methods and Results Whole‐body magnetic resonance imaging was done in 82 adolescents (39 overweight/obese; 36 female; median age, 16.3 [interquartile range, 14.4–18.1] years) to measure body composition and cardiovascular remodeling markers. Left ventricular diastolic function was assessed by echocardiography. Waist, waist:height ratio, and body mass index z scores were calculated. Residualized nonadipose tissue, subcutaneous adipose tissue, and visceral adipose tissue variables, uncorrelated with each other, were constructed using partial regression modeling to allow comparison of their individual contributions in a 3‐compartment body composition model. Cardiovascular variables mostly related to nonadipose rather than adipose tissue. Nonadipose tissue was correlated positively with left ventricular mass (r=0.81), end‐diastolic volume (r=0.70), stroke volume (r=0.64), left ventricular mass:end‐diastolic volume (r=0.37), and systolic blood pressure (r=0.35), and negatively with heart rate (r=−0.33) (all P

Background: Blood-based biomarkers reflecting different components of cardiovascular pathophysiology are now used increasingly in patients with Fontan circulation due to univentricular congenital heart disease. Feeding alters haemodynamics significantly and, thus, may affect biomarker levels. As the haemodynamic responses to a meal differ between Fontan patients and normal subjects, we hypothesised that biomarker kinetics may also vary between these populations. Methods: In 15 patients with Fontan physiology, and 15 matched healthy volunteers, 4 heart failure biomarkers were measured under fasting conditions, and 3 after additional timepoints over 2 h following ingestion of a standardised liquid meal. Changes in biomarker levels over time and the effect of Fontan physiology, sex and age were tested using repeated-measures mixed models. Results: Under fasting conditions, high-sensitivity C-reactive protein (hsCRP), mid-regional pro-adrenomedullin (MR-proADM) and C-terminal pro-endothelin-1 (CT-proET-1) were raised significantly in Fontan patients compared to controls. Postprandially, mid-regional pro-atrial natriuretic peptide (MR-proANP) decreased significantly in patients (max. mean decrease ∼7% after 120 min). Conversely, it increased in normal subjects (max. mean increase ∼8% after 60 min). The remaining biomarkers did not change significantly. Conclusions: The ingestion of food triggers contrary deflections of MR-proANP levels in patients with Fontan circulation compared to normal subjects. Therefore, this parameter should be assessed under fasting conditions in order to correct for postprandial variability.

Abstract Background Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity. Methods A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function. Results The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities. Conclusion Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers.