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Vascular function in adults with cyanotic congenital heart disease
Julie Bjerre Tarp1,2, Peter Clausen3, David Celermajer4
1Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Adults with cyanotic congenital heart disease (CCHD) show preserved brachial artery FMD but impaired NID and lower reactive hyperemia. CCHD patients have a similar risk of atherosclerosis as controls, despite altered vascular markers.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Congenital Heart Disease Research
Background:
- Cyanotic congenital heart disease (CCHD) may be associated with a reduced burden of atherosclerosis.
- Endothelial dysfunction, an early marker of atherosclerosis, has yielded variable results in prior CCHD studies.
- This study investigates endothelial function and carotid atherosclerosis in a larger cohort of adult CCHD patients.
Purpose of the Study:
- To assess endothelial function in adults with CCHD compared to controls.
- To evaluate carotid atherosclerosis, including intima-media thickness and plaque prevalence, in CCHD patients.
- To analyze vascular and inflammatory markers in relation to endothelial function in CCHD.
Main Methods:
- Multicenter study assessing brachial artery flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID).
- Ultrasonographic evaluation of carotid intima-media thickness (CIMT) and plaque characteristics.
- Measurement of lipoproteins, inflammatory markers, and sphingosine-1-phosphate (S1P).
Main Results:
- CCHD patients exhibited lower reactive hyperemia but preserved FMD compared to controls.
- Endothelium-independent NID was reduced in CCHD patients (p=0.053).
- No significant differences in CIMT or carotid plaque prevalence were observed; CCHD patients had lower HDL and higher inflammatory markers and S1P.
Conclusions:
- Adults with CCHD demonstrate preserved brachial artery FMD but impaired NID and reduced reactive hyperemia.
- Comparable carotid atherosclerosis suggests CCHD patients share similar atherosclerosis risk as controls.
- Altered vascular and inflammatory markers warrant further investigation in CCHD management.
Background:
Patients with cyanotic congenital heart disease (CCHD) may have a low burden of atherosclerosis. Endothelial dysfunction is an early stage of atherosclerosis and endothelial function is previously studied in smaller CCHD groups with different techniques and variable results. We aimed to examine endothelial function and carotid atherosclerosis in a larger group of CCHD patients.
Methods:
This multicentre study assessed endothelial function in adults with CCHD and controls by measuring the dilatory response of the brachial artery to post-ischemic hyperaemia (endothelium-dependent flow-mediated-vasodilatation (FMD)), and to nitroglycerin (endothelium-independent nitroglycerin-induced dilatation (NID)). Flow was measured at baseline and after ischaemia (reactive hyperaemia). Carotid-intima-media-thickness (CIMT), prevalence of carotid plaque and plaque thickness (cPT-max) were evaluated ultrasonographically. Lipoproteins, inflammatory and vascular markers, including sphingosine-1-phosphate (S1P) were measured.
Results:
Forty-five patients with CCHD (median age 50 years) and 45 matched controls (median age 52 years) were included. The patients presented with lower reactive hyperaemia (409 ± 114% vs. 611 ± 248%, p < 0.0001), however preserved FMD response compared to controls (106.5 ± 8.3% vs. 106.4 ± 6.1%, p = 0.95). In contrast, NID was lower in the patients (110.5 ± 6.1% vs. 115.1 ± 7.4%, p = 0.053). There was no difference in CIMT, carotid plaque or cPT-max. The patients presented with lower high-density-lipoprotein cholesterol, and higher level of inflammatory markers and S1P.
Conclusion:
Adults with CCHD had preserved FMD in the brachial artery, but impaired NID response and lower reactive hyperaemia than controls. The preserved FMD and the comparable prevalence of carotid atherosclerosis indicate that CCHD patients have the same risk of atherosclerosis as controls.
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