Lasso-Mendez Juliana, Spence Christopher, Hornberger Lisa K, Sivak Allison, Davenport Margie H
Division of Cardiology, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiology, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2025 Jan;41(1):71-86. doi: 10.1016/j.cjca.2024.10.021. Epub 2024 Oct 28.
Congenital heart disease (CHD) affects 1% of live births and is a risk factor for cardiovascular disease and reduced life expectancy. Previous studies have suggested CHD is associated with impaired vascular health, but this has not been established. Therefore, the objective of this study was to examine the effect of CHD on vascular health.
Eight electronic databases were searched through April 12, 2024. Studies of all designs (except case studies and reviews) that reported on the population (individuals with CHD of any age), comparator (individuals without CHD), and outcomes of interest: endothelial dependent (flow-mediated vasodilation, reactive hyperemia index) and independent (nitroglycerin-mediated dilation) vascular function, arterial stiffness (pulse wave velocity, stiffness index, augmentation index, distensibility, and compliance), and carotid intima-media thickness were included. Results are presented as standardized mean difference (SMD) with 95% confidence interval (CI) and as effect size.
We included 138 studies (N = 16,115) in the meta-analysis. Individuals with CHD exhibited decreased vascular function compared with those without including decreased low-mediated vasodilation (SMD, -0.96 [95% CI, -1.22 to -0.70]; I = 85%; large effect size), reactive hyperemia index using ultrasound (SMD, -2.88 [95% CI, -4.85 to -0.90]; I = 96%; large effect size), and nitroglycerin-mediated dilation (SMD, -0.98 [95% CI, -1.35 to -0.61]; I = 87%; large effect size). Various CHD subtypes including coarctation of the aorta, transposition of the great arteries, and tetralogy of Fallot, after the Fontan procedure showed significant vascular dysfunction. Shunt lesions did not show significant vascular dysfunction.
CHD is associated with vascular dysfunction, increased arterial stiffness, and greater carotid intima-media thickness in pediatric and adult patients.
先天性心脏病（CHD）影响1%的活产婴儿，是心血管疾病的危险因素，会缩短预期寿命。先前的研究表明CHD与血管健康受损有关，但尚未得到证实。因此，本研究的目的是探讨CHD对血管健康的影响。
检索了截至2024年4月12日的八个电子数据库。纳入所有设计类型的研究（病例研究和综述除外），这些研究报告了研究对象（任何年龄的CHD患者）、对照（非CHD患者）以及感兴趣的结局：内皮依赖性（血流介导的血管舒张、反应性充血指数）和非内皮依赖性（硝酸甘油介导的舒张）血管功能、动脉僵硬度（脉搏波速度、僵硬度指数、增强指数、扩张性和顺应性）以及颈动脉内膜中层厚度。结果以标准化均数差（SMD）及其95%置信区间（CI）和效应量表示。
我们在荟萃分析中纳入了138项研究（N = 16,115）。与非CHD患者相比，CHD患者的血管功能下降，包括低介导的血管舒张降低（SMD，-0.96 [95% CI，-1.22至-0.70]；I² = 85%；大效应量）、超声检测的反应性充血指数降低（SMD，-2.88 [95% CI，-4.85至-0.90]；I² = 96%；大效应量）以及硝酸甘油介导的舒张降低（SMD，-0.98 [95% CI，-1.35至-0.61]；I² = 87%；大效应量）。各种CHD亚型，包括主动脉缩窄、大动脉转位和法洛四联症，在Fontan手术后显示出明显的血管功能障碍。分流性病变未显示出明显的血管功能障碍。
在儿童和成人患者中，CHD与血管功能障碍、动脉僵硬度增加以及颈动脉内膜中层厚度增加有关。
