Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands.
Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.
Am Heart J. 2018 Jul;201:49-53. doi: 10.1016/j.ahj.2018.04.004. Epub 2018 Apr 6.
Hypertension is common in patients with coarctation of the aorta (CoA), even after successful repair. Increased aortic stiffness has been implicated in the pathology of CoA-associated hypertension. This study aimed to investigate aortic vascular function and its relationship with hypertension in well-repaired CoA-patients at long-term follow-up. Furthermore, we assessed the additive effect of hypertension to adverse arterioventricular coupling associated with increased aortic stiffness.
Twenty-two CoA-patients (age 30 ± 10.6 years) with successful surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) between 3 months and 16 years of age with a follow-up of >10 years and 22 healthy controls underwent cardiac magnetic resonance imaging (CMR), at mean follow-up of 29.3 years, to study aortic pulse wave velocity (PWV), aortic distensibility, global left ventricular (LV) function, LV dimensions, and LV myocardial deformation.
CoA-patients had significantly increased aortic arch PWV (5.6 ± 1.9 m/s vs. 4.5 ± 1.0 m/s, P = .02) and decreased distensibility (4.5 ± 1.8 × 10-3 mmHg vs. 5.8 ± 1.8 × 10-3 mmHg, P = .04) compared to controls. Significant differences in aortic arch PWV were found between hypertensive patients, normotensive patients and controls (6.1 ± 1.8 m/s vs. 4.9 ± 1.9 m/s and 4.5 ± 1.0 m/s, respectively, P = .03). Aortic arch PWV and distensibility were correlated with systolic blood pressure (R = 0.37 and R = -0.37, respectively, P = .03 for both). Global LV function, LV mass, LV dimensions and myocardial deformation were similar in CoA-patients when compared to controls.
Central aortic stiffness is significantly increased in well-repaired CoA-patients long-term after repair, and is associated with hypertension. Global LV function, myocardial deformation indices and LV dimensions are however preserved.
高血压在主动脉缩窄（CoA）患者中很常见，即使在成功修复后也是如此。主动脉僵硬增加与 CoA 相关高血压的病理学有关。本研究旨在探讨长期随访中修复良好的 CoA 患者的主动脉血管功能及其与高血压的关系。此外，我们评估了高血压对与主动脉僵硬增加相关的不利房室耦联的附加影响。
22 例 CoA 患者（年龄 30±10.6 岁），在 3 个月至 16 岁时接受了成功的手术修复（n=12）或球囊血管成形术（BA）（n=10），随访时间超过 10 年，共 22 例健康对照者接受了心脏磁共振成像（CMR）检查，平均随访 29.3 年，以研究主动脉脉搏波速度（PWV）、主动脉可扩张性、整体左心室（LV）功能、LV 尺寸和 LV 心肌变形。
CoA 患者的主动脉弓 PWV（5.6±1.9 m/s 比 4.5±1.0 m/s，P=0.02）和顺应性（4.5±1.8×10-3 mmHg 比 5.8±1.8×10-3 mmHg，P=0.04）均显著增加与对照组相比。高血压患者、正常血压患者和对照组之间的主动脉弓 PWV 存在显著差异（分别为 6.1±1.8 m/s、4.9±1.9 m/s 和 4.5±1.0 m/s，P=0.03）。主动脉弓 PWV 和顺应性与收缩压呈正相关（R=0.37 和 R=-0.37，P=0.03）。与对照组相比，CoA 患者的整体 LV 功能、LV 质量、LV 尺寸和心肌变形相似。
修复良好的 CoA 患者在修复后长期，中心主动脉僵硬显著增加，并与高血压相关。然而，整体 LV 功能、心肌变形指数和 LV 尺寸得以保留。
