Prognostic implications of residual mild coarctation gradient after interventional repair.
catheter intervention
coarctation of the aorta
residual mild coarctation
Journal
Journal of clinical hypertension (Greenwich, Conn.)
ISSN: 1751-7176
Titre abrégé: J Clin Hypertens (Greenwich)
Pays: United States
ID NLM: 100888554
Informations de publication
Date de publication:
27 Jul 2024
27 Jul 2024
Historique:
revised:
08
07
2024
received:
17
04
2024
accepted:
09
07
2024
medline:
29
7
2024
pubmed:
29
7
2024
entrez:
29
7
2024
Statut:
aheadofprint
Résumé
There is limited data on the prognostic implications of residual mild coarctation (RMC) in patients with repaired native coarctation of the aorta (CoA). To explore the association of RMC with mid-term comorbidities in post-interventional patients, and the predictive value of the residual pressure gradient. The authors retrospectively analyzed 79 native CoA patients who received successful intervention at our hospital between October 2010 and June 2023. The outcomes of the study were late arterial hypertension (either raised blood pressure or commencement of hypotensive medications) only in normotensive patients at early follow-up and the composite mid-term comorbidities including new-onset aortic injury, re-stenosis, and re-intervention. At a median follow-up of 60 months, late hypertension and mid-term comorbidities occurred in 16 (28.1%) and nine (11.4%) patients, respectively. Multivariate Cox proportional hazard regression analysis identified invasive peak systolic CoA pressure gradient (PSPG) as the best independent predictor of both outcomes. The maximally selected rank statistics indicated 10 mm Hg as the best PSPG cut-off value for predicting late hypertension. Compared to patients with PSPG < 11 mm Hg, the cumulative event rates of both outcomes were higher in those with PSPG ≥ 11 mm Hg (log-rank test, p < .001 for both endpoints). PSPG ≥ 11 mm Hg was proved to be the independent predictor of late hypertension with a significantly increased risk. In patients with non-surgical CoA repair, the post-interventional RMC and PSPG ≥11 mm Hg are important predictors of clinical comorbidities at mid-term follow-up.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.
Références
Cheng W, Li Z, Ye Z, et al. Stent implantation and balloon angioplasty for native and recurrent coarctation of the aorta. Int Heart J. 2023;64(1):10‐21.
Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease) developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(23):e143‐e263.
Marshall AC, Perry SB, Keane JF, Lock JE. Early results and medium‐term follow‐up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J. 2000;139(6):1054‐1060.
Bouchart F, Dubar A, Tabley A, et al. Coarctation of the aorta in adults: surgical results and long‐term follow‐up. Ann Thorac Surg. 2000;70(5):1483‐1489.
Egbe AC, Miranda WR, Warnes CA, et al. Persistent hypertension and left ventricular hypertrophy after repair of native coarctation of aorta in adults. Hypertension. 2021;78(3):672‐680.
Keshavarz‐Motamed Z, Rikhtegar Nezami F, Partida RA, et al. Elimination of transcoarctation pressure gradients has no impact on left ventricular function or aortic shear stress after intervention in patients with mild coarctation. JACC Cardiovasc Interv. 2016;9(18):1953‐1965.
Oliver JM, Gallego P, Gonzalez A, Aroca A, Bret M, Mesa JM. Risk factors for aortic complications in adults with coarctation of the aorta. J Am Coll Cardiol. 2004;44(8):1641‐1647.
Egbe AC, Miranda WR, Jain CC, Borlaug BA, Connolly HM. Prognostic implications of exercise‐induced hypertension in adults with repaired coarctation of aorta. Hypertension. 2022;79(12):2796‐2805.
Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC guidelines for the management of grown‐up congenital heart disease (new version 2010). Eur Heart J. 2010;31(23):2915‐2957.
Iriart X, Laik J, Cremer A, et al. Predictive factors for residual hypertension following aortic coarctation stenting. J Clin Hypertens (Greenwich). 2019;21(2):291‐298.
Williams B, Mancia G, Spiering W, et al. 2018 practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2018;36(12):2284‐2309.
Flynn JT, Kaelber DC, Baker‐Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.
Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R, Investigators* C. Intermediate outcomes in the prospective, multicenter coarctation of the aorta stent trial (COAST). Circulation. 2015;131(19):1656‐1664.
Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long‐term outcomes of the coarctation of the aorta stent trials. Circ Cardiovasc Interv. 2021;14(6):e010308.
Quennelle S, Powell AJ, Geva T, Prakash A. Persistent aortic arch hypoplasia after coarctation treatment is associated with late systemic hypertension. J Am Heart Assoc. 2015;4(7):e001978.
Egbe AC, Allison TG, Ammash NM. Mild coarctation of aorta is an independent risk factor for exercise‐induced hypertension. Hypertension. 2019;74(6):1484‐1489.
Bhatt AB, Defaria Yeh D. Long‐term outcomes in coarctation of the aorta: an evolving story of success and new challenges. Heart. 2015;101(15):1173‐1175.
Shaddy RE, Boucek MM, Sturtevant JE, et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation. 1993;87(3):793‐799.
Fawzy ME, Sivanandam V, Galal O, et al. One‐ to ten‐year follow‐up results of balloon angioplasty of native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol. 1997;30(6):1542‐1546.
Rinnstrom D, Dellborg M, Thilen U, et al. Poor blood pressure control in adults with repaired coarctation of the aorta and hypertension: a register‐based study of associated factors. Cardiol Young. 2017;27(9):1708‐1715.
Lee MGY, Allen SL, Koleff J, et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg. 2018;53(3):531‐537.
Vriend JW, Zwinderman AH, de Groot E, Kastelein JJ, Bouma BJ, Mulder BJ. Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation. Eur Heart J. 2005;26(1):84‐90.
Toro‐Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long‐term follow‐up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89(5):541‐547.
Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta. Long‐term follow‐up and prediction of outcome after surgical correction. Circulation. 1989;80(4):840‐845.
de Divitiis M, Pilla C, Kattenhorn M, et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol. 2003;41(12):2259‐2265.
Niwa K, Perloff JK, Bhuta SM, et al. Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses. Circulation. 2001;103(3):393‐400.
Carminati M. Prime time for transcatheter treatment of coarctation of the aorta. JACC Cardiovasc Interv. 2023;16(4):454‐456.
Eriksson P, Pihkala J, Jensen AS, et al. Transcatheter intervention for coarctation of the aorta: a nordic population‐based registry with long‐term follow‐up. JACC Cardiovasc Interv. 2023;16(4):444‐453.
Ou P, Bonnet D, Auriacombe L, et al. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J. 2004;25(20):1853‐1859.
Vigneswaran TV, Sinha MD, Valverde I, Simpson JM, Charakida M. Hypertension in coarctation of the aorta: challenges in diagnosis in children. Pediatr Cardiol. 2018;39(1):1‐10.
Simsolo R, Grunfeld B, Gimenez M, et al. Long‐term systemic hypertension in children after successful repair of coarctation of the aorta. Am Heart J. 1988;115(6):1268‐1273.