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Aortic morphology and distensibility influence clinical outcomes after aortic coarctation treatment
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Mariana Timóteo Lemos
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.3 Congenital Heart Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Mariana Timóteo Lemos; João Rato; Miguel Fogaça Da Mata; Rita Ataíde; Mafalda Sequeira; Susana Cordeiro; Rui Anjos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Introduction: Aortic coarctation is a systemic vascular disease that predisposes patients to several comorbidities, even after successful treatment. Our aim was to investigate the role of aortic morphology and distensibility on relevant outcomes in patients with treated aortic coarctation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Methods: Asymptomatic adolescents and young adults with treated aortic coarctation with no gradient or with borderline gradients (<u>></u>20 and ≤25mmHg) were prospectively evaluated. Echocardiography was performed at rest and peak exercise. Pulse wave velocity (PWV) was evaluated between the right carotid and right radial arteries. Aortic hypoplasia was calculated as the ratio of narrowest diameter of the aortic arch to aortic diameter at the diaphragm level (AoArch/AoDiaphr) by cardiac MR. Univariate and multivariate linear regression models were used to evaluate the impact of PWV, AoArch/AoDiaphr, and isthmic Doppler gradient at rest (gradr) and peak exercise (gradp), on the following variables: systolic blood pressure (SBP) at rest and peak exercise, ambulatory 24-hour SBP, and indexed left ventricular mass (ILVM). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Results: Our sample comprised 43 patients (60.5% male), with a mean age of 21.2 years (range 12–40), at a mean of 14.6 years (range 0.6–34.0) after aortic coarctation treatment. Office SBP correlated with PWV (β=2.9, p=0.011), AoArch/AoDiaphr (β.=-44.1, p=0.01), gradr (β=0.8, p=0.042), and gradp (β=0.5, p=0.001). Multivariable analysis identified PWV (p=0.006) and gradp (p=0.001) as the strongest determinants of office SBP (adjusted R<sup>2</sup>=0.36). PWV was significantly associated with mean nocturnal SBP (β=2.3, p=0.031), but not with mean 24-hour ambulatory SBP (β=1.8, p=0.052). Peak exercise SBP was determined by gradp (β=1.0, p=0.002). Patients in the group with borderline gradient had a higher SBP at rest and with exercise (p=0.001 and p=0.014, respectively). Finally, ILVM was inversely associated with AoArch/AoDiaphr (β=-50.5, p=0.033).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Conclusion: Aortic coarctation outcomes at follow-up are influenced by morphological and functional aortic properties with variable impact. Higher SBP at rest (office visits and night time) is related to a lower distensibility. Higher exercise SBP is dependent of higher isthmic gradients during exercise. The degree of aortic arch hypoplasia is the major determinant of ventricular hypertrophy. These results have implications on the type of routine evaluation.</span></span></span></p>
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