TY - JOUR
T1 - Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation
AU - Vriend, Joris W. J.
AU - Zwinderman, Aeiko H.
AU - de Groot, Eric
AU - Kastelein, John J. P.
AU - Bouma, Berto J.
AU - Mulder, Barbara J. M.
PY - 2005
Y1 - 2005
N2 - Aims The significance of mild residual. descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient &GE; 30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio < 0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 mate) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1-52.5 years), mean age at repair 8.1 years (range 0.02-37.3 years), mean arm/leg gradient 2 &PLUSMN; 12 mmHg, and mean common carotid intima-media thickness 0.612 &PLUSMN; 0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P < 0.001) and common carotid intima-media thickness (P = 0.027). Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima-media thickness. Our data suggest that a threshold for re-intervention of residual. aortic narrowing tower than posed in current guidelines may be desirable to improve Long-term outcome in these patients. However, further research on such aggressive interventional. approaches is needed
AB - Aims The significance of mild residual. descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient &GE; 30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio < 0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 mate) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1-52.5 years), mean age at repair 8.1 years (range 0.02-37.3 years), mean arm/leg gradient 2 &PLUSMN; 12 mmHg, and mean common carotid intima-media thickness 0.612 &PLUSMN; 0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P < 0.001) and common carotid intima-media thickness (P = 0.027). Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima-media thickness. Our data suggest that a threshold for re-intervention of residual. aortic narrowing tower than posed in current guidelines may be desirable to improve Long-term outcome in these patients. However, further research on such aggressive interventional. approaches is needed
U2 - https://doi.org/10.1093/eurheartj/ehi004
DO - https://doi.org/10.1093/eurheartj/ehi004
M3 - Article
C2 - 15615804
SN - 0195-668X
VL - 26
SP - 84
EP - 90
JO - European Heart journal
JF - European Heart journal
IS - 1
ER -