Quail Michael A, Short Rebekah, Pandya Bejal, Steeden Jennifer A, Khushnood Abbas, Taylor Andrew M, Segers Patrick, Muthurangu Vivek
From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
Hypertension. 2017 Mar;69(3):501-509. doi: 10.1161/HYPERTENSIONAHA.116.08763. Epub 2017 Jan 23.
Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, =0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m, <0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.
由于血管结构和功能异常，主动脉缩窄修复术后的患者被认为后负荷增加。我们开发了一种新型心血管磁共振方案，可用于评估中心血流动力学，包括中心主动脉收缩压、阻力、总动脉顺应性、脉搏波速度和波反射。主要研究目的是：（1）描述中心主动脉收缩压和外周收缩压的组间差异；（2）全面评估两组的后负荷（包括波反射）；（3）在与左心室质量（LVM）升高相关的协变量中确定可能的生物标志物。招募了50名主动脉缩窄修复术后的成年患者和25名年龄及性别匹配的对照者。使用高时间分辨率螺旋相位对比心血管磁共振血流序列获取升主动脉面积和血流波形。这些数据用于无创推导中心血流动力学并进行波强度分析。使用多变量线性回归分析评估与LVM相关的协变量。肱动脉收缩压、平均压或舒张压在两组间无显著差异（≥0.1）。然而，患者的中心主动脉收缩压显著高于对照组（113对107 mmHg，P = 0.002）。与对照组相比，患者的总动脉顺应性降低、脉搏波速度增加且反向压缩波更大。患者的LVM指数显著高于对照组（72对59 g/m²，P < 0.0005）。反向压缩波的大小与LVM的变化独立相关（P = 0.01）。通过一种新型的无创血流动力学评估，我们发现主动脉缩窄修复术后管道血管功能异常，包括与LVM升高相关的异常波反射。
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