Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Am Heart J. 2021 Nov;241:50-58. doi: 10.1016/j.ahj.2021.07.005. Epub 2021 Jul 18.
Brachial systolic blood pressure (BP) is the most commonly used metric for monitoring hypertension. However, recent studies suggest that brachial systolic BP underestimates left ventricle (LV) systolic load in patients with coarctation of aorta (COA). Since brachial systolic BP is used as a surrogate of arterial afterload in clinical practice, it is important to determine how well it correlates with LV remodeling and stiffness in patients with COA as compared to patients with idiopathic hypertension.
This is cross-sectional study of COA patients with hypertension (COA group) and adults with idiopathic hypertension (control group). Both groups were matched 1:1 based on age, sex, BMI and systolic BP. We hypothesized that the COA group will have higher LV systolic and diastolic stiffness, and more advanced left atrial remodeling and pulmonary hypertension. We assessed LV systolic stiffness using end-systolic elastance, and diastolic stiffness using LV stiffness constant and chamber capacitance (LV-end-diastolic volume at an end-diastolic pressure of 20mm Hg) RESULTS: There were 112 patients in each group. Although both groups had similar systolic BP, the COA group had a higher end-systolic elastance (2.37 ± 0.74 vs 2.11 ± 0.54 mm Hg/mL, P= .008), higher LV stiffness constant (6.91 ± 0.81 vs 5.93 ± 0.79, P= .006) and lower LV-end-diastolic volume at an end-diastolic pressure of 20mm Hg (58 ± 9 vs 67 ± 11 mL/m, P< .001). Additionally, the COA group had more advanced left atrial remodeling and higher pulmonary artery pressures which is corroborating evidence of high LV filling pressure.
COA patients have more LV stiffness and abnormal hemodynamics compared to non-COA patients with similar systolic BP, suggesting that systolic BP may underestimate LV systolic load in this population. Further studies are required to determine whether the observed LV stiffness and dysfunction translates to more cardiovascular events during follow-up, and whether adopting a stricter systolic BP target in clinical practice or changing threshold for COA intervention will lead to less LV stiffness and better clinical outcomes.
肱动脉收缩压（BP）是监测高血压最常用的指标。然而，最近的研究表明，在主动脉缩窄（COA）患者中，肱动脉收缩压低估了左心室（LV）收缩负荷。由于在临床实践中，肱动脉收缩压被用作动脉后负荷的替代指标，因此确定它与 COA 患者的 LV 重构和僵硬的相关性如何，与特发性高血压患者相比，这一点非常重要。
这是一项 COA 合并高血压患者（COA 组）和特发性高血压成人（对照组）的横断面研究。两组均根据年龄、性别、BMI 和收缩压进行 1:1 匹配。我们假设 COA 组的 LV 收缩和舒张僵硬程度更高，左心房重构和肺动脉高压程度更严重。我们使用收缩末期弹性评估 LV 收缩僵硬，使用 LV 僵硬常数和腔室电容（在 20mmHg 舒张末期压力下的 LV 舒张末期容积）评估 LV 舒张僵硬。
每组有 112 名患者。尽管两组的收缩压相似，但 COA 组的收缩末期弹性更高（2.37±0.74 比 2.11±0.54mmHg/mL，P=0.008），LV 僵硬常数更高（6.91±0.81 比 5.93±0.79，P=0.006），在 20mmHg 舒张末期压力下的 LV 舒张末期容积更低（58±9 比 67±11mL/m，P<0.001）。此外，COA 组的左心房重构程度更严重，肺动脉压力更高，这证实了 LV 充盈压较高。
与收缩压相似的非 COA 患者相比，COA 患者的 LV 僵硬程度更高，血液动力学异常更严重，这表明在该人群中，收缩压可能低估了 LV 收缩负荷。需要进一步研究来确定观察到的 LV 僵硬和功能障碍是否会导致随访期间发生更多心血管事件，以及在临床实践中采用更严格的收缩压目标或改变 COA 干预阈值是否会导致 LV 僵硬程度降低和更好的临床结局。
