BACKGROUND: Patients with vascular stiffening may display increased arterial afterload that is out of proportion to systolic blood pressure (SBP). Since vascular and endothelial dysfunction develop in patients with coarctation of aorta (COA), we hypothesized that for any SBP, patients with mild COA (COA peak velocity <2 m/s) will have a higher arterial afterload and increased left ventricular mass index (LVMI) compared with controls, and that Doppler-derived arterial load indices would be a better predictor of LVMI compared with SBP alone. METHODS: We studied 204 COA patients (age 35±12 y) and 204 matched controls. Doppler-derived arterial afterload was assessed using effective arterial elastance index and total arterial compliance index. RESULTS: Despite similar SBP, the mild COA group displayed higher arterial afterload as evidenced by a higher elastance index (3.3±0.9 versus 2.9±0.7 mm Hg/mL·m2; P<0.001) and lower total arterial compliance index (0.8±0.3 versus 1.2±0.5 mL/mm Hg·m2; P<0.001). This was associated with higher LVMI in COA (109±35 versus 93±32, g/m2; P<0.001). Compared with SBP (β=0.24 [95% CI, 0.02-0.45]), elastance index (β=20.2 [95% CI, 15.8-44.1]) and total arterial compliance index (β=-32.5 [95% CI, -43.8 to -123.6]) were better predictors of LVMI. Elastance index (but not SBP) was predictive of longitudinal increases in LVMI (r=0.43, P<0.001). CONCLUSIONS: COA patients had higher arterial afterload compared with controls with similar SBP. In comparison to SBP, Doppler-derived arterial load indices correlate more strongly with LV hypertrophy. These data suggest that SBP may underestimate LV afterload in this population. This has important clinical implications since titration of antihypertensive therapy is currently based on SBP.
BACKGROUND:Patients with vascular stiffening may display increased arterial afterload that is out of proportion to systolic blood pressure (SBP). Since vascular and endothelial dysfunction develop in patients with coarctation of aorta (COA), we hypothesized that for any SBP, patients with mild COA (COA peak velocity <2 m/s) will have a higher arterial afterload and increased left ventricular mass index (LVMI) compared with controls, and that Doppler-derived arterial load indices would be a better predictor of LVMI compared with SBP alone. METHODS: We studied 204 COApatients (age 35±12 y) and 204 matched controls. Doppler-derived arterial afterload was assessed using effective arterial elastance index and total arterial compliance index. RESULTS: Despite similar SBP, the mild COA group displayed higher arterial afterload as evidenced by a higher elastance index (3.3±0.9 versus 2.9±0.7 mm Hg/mL·m2; P<0.001) and lower total arterial compliance index (0.8±0.3 versus 1.2±0.5 mL/mm Hg·m2; P<0.001). This was associated with higher LVMI in COA (109±35 versus 93±32, g/m2; P<0.001). Compared with SBP (β=0.24 [95% CI, 0.02-0.45]), elastance index (β=20.2 [95% CI, 15.8-44.1]) and total arterial compliance index (β=-32.5 [95% CI, -43.8 to -123.6]) were better predictors of LVMI. Elastance index (but not SBP) was predictive of longitudinal increases in LVMI (r=0.43, P<0.001). CONCLUSIONS:COApatients had higher arterial afterload compared with controls with similar SBP. In comparison to SBP, Doppler-derived arterial load indices correlate more strongly with LV hypertrophy. These data suggest that SBP may underestimate LV afterload in this population. This has important clinical implications since titration of antihypertensive therapy is currently based on SBP.
Entities:
Keywords:
aorta; aortic coarctation; blood pressure; hypertension; left ventricular hypertrophy
Authors: Dena Ettehad; Connor A Emdin; Amit Kiran; Simon G Anderson; Thomas Callender; Jonathan Emberson; John Chalmers; Anthony Rodgers; Kazem Rahimi Journal: Lancet Date: 2015-12-24 Impact factor: 79.321
Authors: Morgan L Brown; Harold M Burkhart; Heidi M Connolly; Joseph A Dearani; Frank Cetta; Zhuo Li; William C Oliver; Carole A Warnes; Hartzell V Schaff Journal: J Am Coll Cardiol Date: 2013-07-10 Impact factor: 24.094
Authors: Melissa G Y Lee; Robyn A Hemmes; Jonathan Mynard; Elisabeth Lambert; Geoffrey A Head; Michael M H Cheung; Igor E Konstantinov; Christian P Brizard; Gavin Lambert; Yves d'Udekem Journal: Int J Cardiol Date: 2017-05-19 Impact factor: 4.164
Authors: J Leandro; J F Smallhorn; L Benson; N Musewe; J W Balfe; J D Dyck; L West; R Freedom Journal: J Am Coll Cardiol Date: 1992-07 Impact factor: 24.094
Authors: R H Marcus; C Korcarz; G McCray; A Neumann; M Murphy; K Borow; L Weinert; J Bednarz; D D Gretler; K T Spencer Journal: Circulation Date: 1994-06 Impact factor: 29.690
Authors: Kristin C Lombardi; Veronika Northrup; Robert L McNamara; Lissa Sugeng; Constance G Weismann Journal: Am J Cardiol Date: 2013-09-13 Impact factor: 2.778
Authors: Alexander C Egbe; William R Miranda; Likhita Shaik; Renuka Reddy Katta; Ahmed Goda Sakr; Janaki Devara; Heidi M Connolly Journal: Blood Press Monit Date: 2022-04-01 Impact factor: 1.444
Authors: Alexander C Egbe; William R Miranda; Janaki Devara; Momina Iftikhar; Likhita Shaik; Renuka Reddy Katta; Heidi M Connolly Journal: CJC Open Date: 2021-01-12
Authors: Timion A Meijs; Savine C S Minderhoud; Steven A Muller; Robbert J de Winter; Barbara J M Mulder; Joost P van Melle; Elke S Hoendermis; Arie P J van Dijk; Nicolaas P A Zuithoff; Gregor J Krings; Pieter A Doevendans; Maarten Witsenburg; Jolien W Roos-Hesselink; Annemien E van den Bosch; Berto J Bouma; Michiel Voskuil Journal: J Am Heart Assoc Date: 2021-11-10 Impact factor: 5.501