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Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta: association with systolic blood pressure in the high normal range
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, 59-64 p.Article in journal (Refereed) Published
Abstract [en]

Background: Arterial hypertension is common in adults with repaired coarctation of the aorta (CoA). The associations between the diagnosis of hypertension, actual blood pressure, other factors affecting left ventricular overload, and left ventricular hypertrophy (LVH) are not yet fully explored in this population.

Material and results: From the national register for congenital heart disease, 506 adult patients (≥18 years old) with previous repair of CoA were identified (37.0% female, mean age 35.7 ± 13.8 years, with an average of 26.8 ± 12.4 years post repair). Echocardiographic data were available for all patients, and showed LVH in 114 (22.5%) of these. Systolic blood pressure (SBP) (mm Hg) (OR 1.02, CI 1.01–1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), diagnosis of arterial hypertension (OR 3.02, CI 1.81–5.02), and sex (female) (OR 0.41, CI 0.24–0.72) were independently associated with LVH. There was an association with LVH at SBP within the upper reference limits [130, 140] mm Hg (OR 2.23, CI 1.05–4.73) that further increased for SBP N 140 mm Hg (OR 8.02, CI 3.76–17.12).

Conclusions: LVH is common post repair of CoA and is associatedwith SBP even belowthe currently recommended target level. Lower target levels may therefore become justified in this population.

Place, publisher, year, edition, pages
2016. Vol. 218, 59-64 p.
Keyword [en]
CoA, Hypertension, Left ventricular hypertrophy, Adult congenital heart disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-126425DOI: 10.1016/j.ijcard.2016.05.033ISI: 000377856300010PubMedID: 27232912OAI: oai:DiVA.org:umu-126425DiVA: diva2:1033111
Available from: 2016-10-05 Created: 2016-10-05 Last updated: 2017-11-30Bibliographically approved
In thesis
1. Coarctation of the aorta: register and imaging studies
Open this publication in new window or tab >>Coarctation of the aorta: register and imaging studies
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Coarctation of the aorta (CoA) constitutes 5-8 % of all congenital heart disease (CHD) and is associated with long-term complications such as hypertension (HTN) and left ventricular hypertrophy (LVH). Factors associated with HTN, LVH, and diffuse myocardial fibrosis, are not yet fully explored in this population.

Methods Papers I-III: The Swedish national register of congenital heart disease (SWEDCON) was used to identify adult patients with repaired CoA.

Paper IV: Data on 2,424 adult patients with CHD was extracted from SWEDCON and compared to controls (n = 4,605) regarding height, weight and body mass index (BMI).

Paper V: Adults with CoA (n = 21, age 28.5 (19.1-65.1) years, 33.3 % female) referred for CMR were investigated with T1 mapping to determine left ventricular extracellular volume fraction (ECV).

Results Papers I-II: Out of 653 patients, 344 (52.7 %) had HTN. In a multivariable model, age (years) (OR 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68) and BMI (kg/m2) (OR 1.09, CI 1.03-1.16) were associated with having HTN, and so was systolic arm-leg blood pressure (BP) gradient where an association was found at the ranges (10, 20] mmHg (OR 3.58, CI 1.70-7.55) and > 20 mmHg (OR 11.38, CI 4.03-32.11), in comparison to the range [0, 10] mmHg.

When investigating 243 patients with diagnosed HTN, 127 (52.3 %) had elevated BP (≥ 140/90 mmHg). Age (years) (OR 1.03, CI 1.01-1.06) was associated with elevated BP, and so was systolic arm-leg BP gradient in the ranges (10, 20] mmHg (OR 4.92, CI 1.76-13.79), and > 20 mmHg (OR 9.93, CI 2.99-33.02), in comparison to the reference interval [0, 10] mmHg.

Patients with elevated BP had more classes of anti-hypertensive medication classes prescribed (1.9 vs 1.5, p = 0.003).

Paper III: Out of 506 patients, 114 (22.5 %) were found to have LVH. Systolic BP (mmHg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), and HTN (OR 3.02, CI 1.81-5.02), were associated with LVH, while sex (female) (OR 0.41, CI 0.24-0.72) was negatively associated with LVH.

Paper IV: There was no difference in height, weight, or BMI between patients with CoA (n = 414) and the reference population.

Paper V: In the population of 21 patients, an increased left ventricular myocardial ECV was found in 6 cases (28.6 %). Of the patients with increased ECV, 5/6 (83.3 %) were female (p = 0.002). Patients with increased ECV did not otherwise differ from the rest of the study population. iv

Conclusions In adults with repaired CoA, HTN and LVH were common, and many patients with HTN had elevated BP despite treatment. The potentially modifiable factors BMI and systolic arm-leg BP gradient were associated with HTN, and the gradient was also associated with elevated BP among patients with diagnosed HTN. The gradient’s significance remained even within what the current guidelines consider acceptable ranges. Potentially modifiable factors associated with LVH were systolic BP and aortic valve disease. We found no general difference in height, weight, or BMI between patients with CoA and the reference population. While LVH was more common among men, increased myocardial ECV was more common among women.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 60 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1842
Keyword
coarctation of the aorta, adult congenital heart disease, hypertension, left ventricular hypertrophy, body mass index, height, weight, register, CMR
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-126428 (URN)978-91-7601-557-5 (ISBN)
Public defence
2016-10-28, Hörsal B Unod T 9, Norrlands Universitetssjukhus, 13:00 (English)
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Available from: 2016-10-07 Created: 2016-10-05 Last updated: 2016-10-06Bibliographically approved

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