De Groote Katya, Devos Daniël, Van Herck Koen, Demulier Laurent, Buysse Wesley, De Schepper Jean, De Wolf Daniël
Division of Paediatric Cardiology, Department of Paediatrics, Ghent University Hospital, De Pintelaan 185, 3K12D, Administratie pediatrie, B-9000, Ghent, Belgium.
Cardiovascular Magnetic Resonance, Department of Radiology, Ghent University Hospital, Ghent, Belgium.
Heart Vessels. 2015 Sep;30(5):618-25. doi: 10.1007/s00380-014-0529-0. Epub 2014 Jun 17.
Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology.
特纳综合征（TS）中的高血压是一个多因素、高度普遍且严重的问题，需要及时诊断和严格治疗。本研究的目的是调查成年TS患者主动脉弓形态异常与高血压之间的关联。这是一项针对74例接受常规心脏磁共振成像（MRI）的成年TS患者（年龄29.41±8.91岁）的单中心回顾性研究。如果血压超过140/90 mmHg和/或接受抗高血压药物治疗，则将患者分配到高血压组（N = 31）。根据横弓曲线以及左颈总动脉-左锁骨下动脉之间的距离，在MRI图像上评估主动脉弓形态，最初分为正常（N = 54）或异常（N = 20）。我们还使用了一种新的更客观的方法，通过确定横弓最高点（AoHP）的相对位置来描述TS患者的主动脉弓异常。逻辑回归分析表明，高血压与年龄、体重指数（BMI）和主动脉弓形态异常显著且独立相关，新的AoHP方法的效应量比传统方法更大。高血压且主动脉弓形态异常的TS患者升主动脉扩张更为常见。TS患者的主动脉弓形态异常与高血压之间存在显著关联，独立于年龄和BMI，且与其他结构性心脏病无关。我们建议将主动脉弓形态纳入TS患者高血压的风险分层，并提出一种新的定量方法来表达主动脉弓形态。
