Department of Pediatrics, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
Department of Pediatric Cardiology, Nagano Children's Hospital, Nagano, Japan.
Pediatr Cardiol. 2024 Dec;45(8):1804-1810. doi: 10.1007/s00246-023-03283-x. Epub 2023 Sep 11.
Atherosclerosis can develop in adult patients with congenital heart disease (CHD) and should be given attention. Endothelial function is well known as a predictor of the development of atherosclerosis but has not been well investigated in patients with repaired CHD. This study aimed to clarify the endothelial function and its relationship with clinical backgrounds and parameters in adolescents with various types of repaired CHDs. Endothelial function was evaluated using peripheral arterial tonometry (PAT). The reactive hyperemia index (RHI) was evaluated and compared between adolescents with repaired CHD and those in the control group. The relationship between the clinical background and parameters was also investigated in patients with repaired CHD. Forty-eight patients with repaired CHD (age 14.0 ± 3.3 years) and 114 healthy volunteers were included in this study. Patients with repaired CHD comprised 16 with repaired non-cyanotic CHD, 14 with repaired tetralogy of Fallot, and 18 who underwent the Fontan procedure. RHI in the repaired CHD group was significantly lower than in the control group. There was no significant correlation between the RHI and blood biochemical markers, such as uric acid, creatine, and brain natriuretic peptide levels. The RHI was significantly higher in patients taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) than in those not taking them. Endothelial function was impaired in adolescents with repaired CHD compared to that in the control group. Microvascular endothelial dysfunction developed even in adolescents with simple non-cyanotic CHD.
动脉粥样硬化可发生于先天性心脏病（CHD）的成年患者，应予以关注。内皮功能是动脉粥样硬化发展的预测因子，但其在修复后的 CHD 患者中尚未得到充分研究。本研究旨在阐明各种修复后的 CHD 青少年的内皮功能及其与临床背景和参数的关系。使用外周动脉张力测定（PAT）评估内皮功能。评估并比较修复后的 CHD 患者与对照组之间的反应性充血指数（RHI）。还研究了修复后的 CHD 患者的临床背景和参数之间的关系。本研究纳入了 48 例修复后的 CHD 患者（年龄 14.0±3.3 岁）和 114 名健康志愿者。修复后的 CHD 患者包括 16 例修复后的非发绀性 CHD、14 例修复后的法洛四联症和 18 例行 Fontan 手术的患者。修复后的 CHD 组的 RHI 明显低于对照组。RHI 与尿酸、肌酸和脑钠肽等血液生化标志物之间无显著相关性。与未服用血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）的患者相比，服用 ACEI 和 ARB 的患者的 RHI 更高。与对照组相比，修复后的 CHD 青少年的内皮功能受损。即使是患有单纯非发绀性 CHD 的青少年，也会出现微血管内皮功能障碍。
