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Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults With Repaired Coarctation of Aorta
Journal article   Open access   Peer reviewed

Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults With Repaired Coarctation of Aorta

Alexander C. Egbe, William R. Miranda, Janaki Devara, Momina Iftikhar, Likhita Shaik, Renuka Reddy Katta and Heidi M. Connolly
CJC open (Online), Vol.3(5), pp.603-608
05/01/2021
DOI: 10.1016/j.cjco.2021.01.001
PMID: 34027365
url
https://doi.org/10.1016/j.cjco.2021.01.001View
Published (Version of record) Open Access

Abstract

Background: Patients with coarctation of aorta (COA) have arterial stiffening, and this is associated with impaired cardiac reserve and hypertensive systolic blood pressure (SBP) response during exercise. However, whether patients with COA have concomitant left ventricular (LV) stiffening and the potential impact of combined ventricular-arterial stiffening on exercise hemodynamics are unknown. Methods: We studied 174 patients with repaired COA (aged 39 +/- 11 years and male 103 [59%]) and 174 matched controls. Our study hypotheses are: (1) patients with COA have higher ventricular-arterial stiffness (end-systolic elastance [Ees] and arterial elastance [Ea]) as compared with controls; (2) ventricular-arterial stiffness was associated with LV stroke volume augmentation (Delta LVSV) and SBP augmentation (Delta SBP) during exercise among patients with COA. Results: Despite similar systolic SBP, patients with COA had higher Ea (1.8 +/- 0.4 vs 1.4 +/- 0.4 mm Hg/mL, P < 0.001), higher Ees (2.41 +/- 0.65 vs 2.17 +/- 0.40 mm Hg/mL, P < 0.001), but similar Ea/Ees (0.87 +/- 0.29 vs 0.83 +/- 0.33, P = 0.2). Delta LVSV was 6.1 +/- 1.4 mL/beat. Combined ventricular-arterial stiffness had a stronger correlation with DLVSV as compared with Ea alone (r = -0.53 vs r = -0.41, P = 0.006) and as compared with Ees alone (r = -0.53 vs r = -0.46, P = 0.02). Delta SBP was 48 +/- 21 mm Hg. Combined ventricular-arterial stiffness had a stronger correlation with Delta SBP as compared with Ea alone (r = 0.57 vs r = 0.43, P < 0.001) and as compared with Ees alone (r = 0.57 vs r = -0.39, P < 0.001). Conclusion: Patients with COA had combined ventricular-arterial stiffening, and this was associated with impaired cardiac reserve and hypertensive SBP response during exercise. These findings provide foundation for further studies to determine whether drugs that reduce both ventricular and arterial stiffness will improve exercise capacity and hemodynamics in this unique population.
 Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology

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