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Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair

Michael A Quail1, Rebekah Short1, Bejal Pandya1

  • 1From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).

Hypertension (Dallas, Tex. : 1979)
|January 25, 2017
PubMed

Insights

Repaired coarctation of the aorta leads to abnormal blood vessel function and higher central aortic pressure. These changes, including abnormal wave reflections, are linked to increased left ventricular mass in patients.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Patients with repaired coarctation of the aorta (CoA) often experience increased afterload due to vascular abnormalities.
  • Assessing central hemodynamics and arterial wave reflections is crucial for understanding cardiovascular risk post-CoA repair.

Purpose of the Study:

  • To characterize hemodynamic differences between patients with repaired CoA and controls.
  • To evaluate afterload, including wave reflections, in repaired CoA patients.
  • To identify biomarkers associated with elevated left ventricular mass (LVM) in this population.

Main Methods:

  • Developed a novel cardiovascular magnetic resonance (CMR) protocol for assessing central hemodynamics noninvasively.
  • Measured central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections.
  • Utilized multivariable linear regression to identify covariates associated with LVM.

Main Results:

  • No significant differences in brachial blood pressure between groups.
  • Significantly higher central aortic systolic blood pressure in repaired CoA patients compared to controls.
  • Repaired CoA patients exhibited reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves.
  • Left ventricular mass index was significantly higher in repaired CoA patients.
  • Magnitude of backward compression waves independently associated with LVM variation.

Conclusions:

  • Novel CMR protocol enables noninvasive assessment of central hemodynamics and wave reflections after CoA repair.
  • Abnormal conduit vessel function, including abnormal wave reflections, is present after CoA repair.
  • Abnormal wave reflections are associated with elevated left ventricular mass in patients with repaired CoA.

Keywords:
blood pressurecongenital heart diseasehemodynamicshypertensionmagnetic resonance imaging

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