儿童孤立性主动脉缩窄治疗后长期血压和高血压的预测因素：一项基于人群的研究。

Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children-a population-based study.

机构信息

Department of Pediatric Cardiology, New Children's hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Department of Pediatric Surgery, New Children's hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

出版信息

Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3). doi: 10.1093/icvts/ivac212.

DOI:10.1093/icvts/ivac212

PMID:35944231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9380783/

Abstract

OBJECTIVES

The aim of this study was to assess predictors of BP and hypertension and relations between BP and LV mass in a population-based retrospective study of repaired isolated coarctation of aorta.

METHODS

We collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000-2012. Systolic hypertension was defined as systolic BP (SBP) z-score ≥+2 standard deviation (SD) or regular use of BP medication. LV hypertrophy was defined as LV mass z-score ≥+2 SD or LV mass index g/m2.7 ≥95th percentile.

RESULTS

The median (25-75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9-13.2) and 11.8 years (7.9-16.0), respectively. Age at first procedure (P = 0.011) and systolic arm-leg-gradient (P = 0.007) were positively and transverse arch (P = 0.007) and isthmus diameter (P = 0.001) z-scores at follow-up were negatively associated with SBP z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; P < 0.001) and arm-leg-gradient at follow-up (mean ± SD, -0.3 ± 14.6 vs -6.4 ± 11.6 mmHg; P = 0.047) adjusted for reintervention for coarctation and age at follow-up. LV hypertrophy was present in 20/227 (9.3%) and related with SBP z-score.

CONCLUSIONS

Higher SBP and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with SBP.

摘要

目的

本研究旨在评估修复性孤立性主动脉缩窄患者的血压（BP）和高血压预测因素，以及 BP 与左心室质量（LV 质量）之间的关系。

方法

我们收集了 2000 年至 2012 年在我院接受手术（n=235）或球囊血管成形术/支架（n=37/12）治疗的 284/304 例（93%）主动脉缩窄患者的随访数据，直至 2018 年。收缩期高血压定义为收缩压（SBP）z 评分≥+2 标准差（SD）或常规使用降压药物。LV 肥厚定义为 LV 质量 z 评分≥+2 SD 或 LV 质量指数 g/m2.7≥95 百分位。

结果

中位（25-75 百分位数）随访时间和随访时年龄分别为 9.7 岁（6.9-13.2）和 11.8 岁（7.9-16.0）。首次手术年龄（P=0.011）和收缩期臂-腿梯度（P=0.007）与 SBP z 评分呈正相关，而随访时的横弓（P=0.007）和峡部直径（P=0.001）z 评分与随访时的 SBP z 评分呈负相关，调整了随访时的年龄和再次介入治疗的需要。284 例患者中有 53 例（18.7%）存在收缩期高血压，与首次手术年龄（中位数 33.2 与 0.6 个月；P<0.001）和随访时的臂-腿梯度（平均±SD，-0.3±14.6 与-6.4±11.6mmHg；P=0.047）呈正相关，调整了再次介入治疗和随访时的年龄。227 例患者中有 20 例（9.3%）存在 LV 肥厚，与 SBP z 评分相关。