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Endothelial dysfunction in adults with congenital heart disease: A systematic review and meta-analysis

Amalia Baroutidou1, Theodoros Dimitroulas2, Alexandra Arvanitaki1,3,4

  • 1First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

European Journal of Clinical Investigation
|December 26, 2024
PubMed

Insights

Adults with congenital heart disease (ACHD) show impaired blood vessel function and increased arterial stiffness. This may explain their higher risk of cardiovascular events, highlighting the need for early detection of vascular damage.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Biology
  • Congenital Heart Disease Research

Background:

  • Adults with congenital heart disease (ACHD) face a lifelong risk of premature cardiovascular events.
  • Endothelial dysfunction and arterial stiffness are implicated mechanisms in ACHD.
  • Early identification of endothelial damage in ACHD is crucial for mitigating adverse events.

Purpose of the Study:

  • To systematically review and meta-analyze micro- and macroangiopathy in adults with congenital heart disease (ACHD).
  • To investigate endothelial function and arterial stiffness in ACHD patients compared to healthy controls.

Main Methods:

  • Systematic search of four major electronic databases (PubMed, CENTRAL, Scopus, Web of Science), ClinicalTrials.gov, and grey literature.
  • Inclusion of studies evaluating endothelial function (flow-mediated dilatation, nitroglycerine-mediated dilatation, peripheral arterial tonometry) and arterial stiffness (pulse wave velocity, augmentation index) in ACHD and controls.
  • PRISMA guidelines followed for study selection and data extraction.

Main Results:

  • 31 studies (1118 ACHD, 794 controls) were included.
  • ACHD patients exhibited attenuated brachial artery endothelium-dependent and -independent vasodilation (FMD, NMD).
  • Impaired microvascular function (PAT) and significantly higher augmentation index were observed in ACHD, while pulse wave velocity showed no significant difference.

Conclusions:

  • Adults with congenital heart disease demonstrate impaired macro- and microvascular function.
  • Elevated arterial stiffness, indicated by a higher augmentation index, is present in ACHD.
  • These vascular abnormalities are potential contributors to the increased risk of adverse cardiovascular events in the ACHD population.
Abstract

Keywords:
ACHDarterial stiffnesscongenital heart diseaseendothelial dysfunctionmicrovascular dysfunctionperipheral microangiopathy

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