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High prevalence of increased left ventricular myocardial extracellular volume fraction in adult women with coarctation of the aorta
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Left ventricular hypertrophy (LVH) is common among patients with coarctation of the aorta (CoA). Cardiovascular magnetic resonance imaging (CMR) can be used to accurately measure left ventricular mass (LVM), but also the myocardial extracellular volume fraction (ECV), which reflects the degree of diffuse myocardial fibrosis.

Aims: This study aimed to investigate the prevalence of increased left ventricular myocardial ECV in adults with CoA, and to assess the relationship between increased ECV and LVH.

Material and methods: Adult patients with CoA (n = 21, age 28.5 (19.1-65.1) years, 33% female, 86% with prior CoA repair) referred clinically for CMR were investigated with T1 and ECV mapping. Clinical and echocardiographic data were retrieved from medical records.

Results: Median ECV was 29.0 (22.0-35.0) %; 29.0 (22.0-33.0) % for men versus 32.0 (27.0-35.0) % for women, p = 0.026). Median LVM indexed to body surface area (BSA) was 71.5 (44.0-99.6) g/m2, and LVM/BSA did not correlate with ECV (r = -0.184, p = 0.450). An increased myocardial ECV exceeding the upper normal limit (30.6 %) was found in 6/21 (29 %) of the patients. Of the patients with increased ECV, 5/6 (83 %) were female (p = 0.002). Patients with increased ECV did not differ from the rest of the study population in terms of age, age at intervention, blood pressure, or functional parameters such as left ventricular volumes or ejection fraction (p > 0.05 for all).

Conclusion: In a clinical population of adults with CoA, increased myocardial ECV was common, and associated with female sex, but not with LVM.

National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-126426OAI: oai:DiVA.org:umu-126426DiVA: diva2:1033115
Available from: 2016-10-05 Created: 2016-10-05 Last updated: 2017-02-13
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)
Opponent
Supervisors
Available from: 2016-10-07 Created: 2016-10-05 Last updated: 2016-10-06Bibliographically approved

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