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Determinants of adverse response to exercise in treated aortic coarctation patients
Session:
CO 18 - Cardiopatias Congénitas
Speaker:
Miguel Fogaça Da Mata
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Miguel Fogaça Da Mata; João Rato; Mariana Lemos; Mafalda Sequeira; Susana Cordeiro; Rui Anjos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Aortic coarctation is associated with several sequelae after treatment, including abnormal responses to exercise. We investigated determinants of adverse outcomes on exercise testing.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Asymptomatic patients with successfully treated aortic coarctation (residual isthmic Doppler gradient ≤ 20mmHg) or with borderline gradient (>20≤25mmHg) were prospectively evaluated with exercise testing and exercise echocardiography. Age at evaluation ranged from 8-40 years (mean 20.6). Exclusion criteria included other significant anomalies. Exercise was performed on a treadmill with a Bruce protocol. Isthmic Doppler gradient and flow pattern was assessed within 30 seconds of peak exercise. Adverse exercise outcome was defined by a composite endpoint consisting of exercise hypertension, isthmic diastolic flow on peak exercise Doppler, or ischemic changes. Clinical, physiological and morphological (MR) data were correlated with exercise test results. Statistical analysis was performed with Stata v13. For binomial variables chi-squared tests were used, for continuous variables we used t-test or Wilcoxon rank sum test. Multivariable logistic regression models were built, and the best models chosen using ROC curves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: Forty-one patients were evaluated. Twelve (29%) reached the endpoint, which did not correlate with age, sex, BMI, type of treatment, or indexed LV mass. The endpoint was strongly associated (p<0.01) with higher baseline office systolic BP (mean 140.0mmHg (95% CI 131.3-148.7) vs. 120.7mmHg (115.2-126.2) for those not reaching the endpoint); with a borderline isthmic Doppler gradient at rest; with a higher Doppler gradient at peak exercise (mean 47.2mmHg (37.2-57.2) vs. 30.8mmHg (26.0-35.6)); and with a lower cardiac MR ratio of narrowest diameter of aortic arch/aortic diameter at diaphragm level (0.71 (0.64-0.79) vs. 0.94 (0.86-1.03)). Multivariable logistic regression, after adjusting for confounders, showed that the ratio of narrowest aortic arch segment diameter/aortic diameter at the diaphragm was the single best predictor of adverse exercise outcome (p<0.01, AUC = 0.9167) with an optimal cut-off point of 0.87.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Treated aortic coarctation patients have a high prevalence of abnormal exercise responses. Persistent aortic hypoplasia determined by a ratio of narrowest aortic arch segment/aorta at the diaphragm <0.87 by MR was found to be the best predictor of adverse outcomes during exercise.</span></span></p>
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