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Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular
Anna Lindow1, Cecilia Kennbäck2, Anna Åkesson3
1Pediatric Cardiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Insights
Common carotid artery intima media thickness (cIMT) is elevated in repaired aortic coarctation (CoA) patients, differing mechanistically from coronary artery disease. Further validation is needed to assess cIMT
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Congenital Heart Disease Research
Background:
- Increased common carotid artery intima media thickness (cIMT) is a significant cardiovascular risk factor.
- cIMT thickening is observed in repaired aortic coarctation (CoA), but its mechanisms and clinical relevance are not well understood.
- Understanding cIMT in repaired CoA is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To investigate the mechanistic insights into cIMT thickening in patients with repaired CoA.
- To compare the arterial wall architecture of repaired CoA patients with coronary artery disease (CAD), other congenital heart diseases (oCHD), and healthy controls.
- To elucidate potential differences in cIMT mechanisms between repaired CoA and CAD.
Main Methods:
- Inclusion of 310 subjects: repaired CoA (n=58), oCHD (n=96), CAD (n=68), and healthy controls (n=88).
- Semiautomated analysis software used to determine cIMT and lumen diameter (LD).
- Linear regression analyses performed, correcting for relevant covariates to assess CCA characteristics.
Main Results:
- Both repaired CoA and CAD patients exhibited significantly increased cIMT and cIMT/LD ratios compared to controls.
- Lumen diameter (LD) was significantly increased only in repaired CoA patients.
- Repaired CoA patients demonstrated decreased common carotid artery (CCA) stiffness, unlike CAD patients, and showed eccentric remodeling, potentially due to increased flow.
Conclusions:
- The mechanism of cIMT thickening in repaired CoA may differ from CAD, characterized by eccentric rather than concentric remodeling.
- Increased flow secondary to compliance mismatch at the CoA repair site might contribute to eccentric remodeling.
- The prognostic value of cIMT in post-CoA patients requires separate validation before clinical management guidance.
Aims:
Increased common carotid artery (CCA) intima media thickness (cIMT) is a well-known risk factor for cardiovascular morbidity and mortality. cIMT thickening has been described in patients with repaired aortic coarctation (CoA), but data on mechanism and clinical relevance in this population are scarce. Our aim was to gain mechanistic insights into cIMT thickening of patients with repaired CoA by comparing their wall architecture to patients with coronary artery disease (CAD), other congenital heart diseases (oCHD), and healthy controls.
Methods And Results:
A total of 310 subjects were included (CoA (n = 58), oCHD (n = 96), CAD (n = 68) and healthy controls (n = 88)). CIMT and lumen diameter (LD) were determined using semiautomated analysis software. Linear regression analyses were performed correcting for relevant covariates. While patients with repaired CoA and CAD both had significantly increased cIMT and cIMT/LD ratios, LD was increased only in CoA patients. Furthermore, patients with repaired CoA had decreased CCA stiffness. CCA characteristics in the oCHD group were not significantly different from controls.
Conclusion:
The mechanism of cIMT thickening in patients with repaired CoA may differ from CAD. While there is concentric remodeling in the latter, we see predominant eccentric remodeling in the CoA group, which could be due to increased flow as a result of compliance mismatch at the CoA repair site. We therefore suggest that the prognostic value of cIMT in post-CoA patients should be validated separately prior to using it to guide clinical management in this group.
