Department of Clinical Sciences, Pediatric Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences, Pediatric Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
Int J Cardiol. 2021 Jan 15;323:47-53. doi: 10.1016/j.ijcard.2020.08.095. Epub 2020 Sep 1.
Coarctation of the Aorta (CoA) is associated with increased aortic stiffness and diastolic left ventricular dysfunction. The mechanisms involved and impact of age remain unclear. It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with repaired CoA.
Multimodal cardiovascular assessment from the ascending aorta to microcirculation and endothelial function was performed prospectively. Statistical analyses included multivariable linear regression and correlation of vascular parameters with age and diastolic function.
Fifty-seven patients with well-repaired CoA and 77 healthy controls were included (age 8-59). There was no significant difference in age, gender, body surface area and BMI between the groups. Ascending aortic distensibility was decreased while common carotid intima media thickness, central augmentation index corrected to a heart rate of 75/min [Aix75], peripheral Aix75 and aging index were increased in the CoA group. Interestingly, in a subgroup analysis of CoA patients with tricuspid vs. bicuspid aortic valves (BAV), only the latter had increased Aix75. Carotid-femoral pulse wave velocity [cfPWV], reactive hyperemia index and microcirculation were not significantly different between CoA and control patients. Diastolic function was impaired in the CoA group relative to controls. Both diastolic function and age correlated moderate-strongly with arterial parameters.
Patients with well repaired CoA have increased proximal arterial stiffness which correlates with diastolic function and age. Increased Aix75 may be attributed to a high prevalence of associated BAV. Neither cfPWV nor peripheral endothelial or microcirculatory function are impaired.
主动脉缩窄（CoA）与主动脉僵硬度增加和舒张期左心室功能障碍有关。目前尚不清楚涉及的机制和年龄的影响。本研究旨在描述修复后的 CoA 患儿和成人的动脉和心脏功能、它们之间的相关性以及年龄的影响。
前瞻性地进行了从升主动脉到微循环和内皮功能的多模态心血管评估。统计分析包括多变量线性回归以及血管参数与年龄和舒张功能的相关性。
本研究共纳入 57 例修复良好的 CoA 患者和 77 例健康对照者（年龄 8-59 岁）。两组间的年龄、性别、体表面积和 BMI 无显著差异。CoA 组升主动脉扩张性降低，而颈总动脉内膜中层厚度、校正至心率 75/min 的中心增强指数[Aix75]、外周 Aix75 和老化指数增加。有趣的是，在 CoA 患者中三尖瓣 vs. 二叶式主动脉瓣（BAV）亚组分析中，只有后者的 Aix75 增加。颈动脉-股动脉脉搏波速度[cfPWV]、反应性充血指数和微循环在 CoA 患者和对照组之间无显著差异。与对照组相比，CoA 组舒张功能受损。舒张功能和年龄与动脉参数均呈中度至强相关性。
修复良好的 CoA 患者近端动脉僵硬度增加，与舒张功能和年龄相关。Aix75 增加可能归因于较高的 BAV 发生率。cfPWV 或外周内皮或微循环功能均未受损。
