Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults With Repaired Coarctation of Aorta

Egbe, Alexander C.; Miranda, William R.; Devara, Janaki; Iftikhar, Momina; Shaik, Likhita; Katta, Renuka Reddy; Connolly, Heidi M.

doi:10.1016/j.cjco.2021.01.001

Cited by 3 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An aortic or mitral valve prosthesis was present in 4 patients (20%) each (coexistent in 1). Ascending to descending aorta peak and mean gradients were 19 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and 13 (7-18) mmHg, respectively. The mean ratio of diameters between the aortic isthmus and the descending thoracic aorta at the diaphragm measured by crosssectional imaging was 0.8 ± 0.2.…”

Section: Resultsmentioning

confidence: 99%

“…Four patients (20%) were in New York Heart Association functional class III-IV, while 4 were asymptomatic. Nine patients had pre-procedural outpatient upper and lower limb blood pressure measured; median systolic pressure gradient was 25 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) mmHg. Detailed information of pre-procedural imaging is depicted in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Peak-to-peak CoA gradient was measured at rest in 14 patients and during maximal exercise in 9. Comparison between rest and exercise peak-to-peak CoA gradients did not show statistically significant differences (12 [3-16] vs. 16 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] mmHg, p = 0.4). All patients had resting peak-to-peak CoA gradients ≤ 20 mmHg.…”

Section: Assessment Of Coarctation Of the Aorta During Exercisementioning

confidence: 99%

“…This is reflected in the American College of Cardiology and the European Society of Cardiology guidelines for management of adult congenital heart disease, where indication for intervention is based on a combination of complications (e.g., hypertension), as well as hemodynamic and anatomic parameters [15,16]. Studies aimed at improving the diagnosis of CoA and recoarctation have analyzed myocardial and hemodynamic response to exercise by non-invasive methods [17][18][19][20]. However, data on exercise invasive hemodynamic evaluation of pulmonary, systemic and ventricular pressures are lacking.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

Miguel¹,

Jain²,

Egbe³

et al. 2022

Congenital Heart Disease

View full text Add to dashboard Cite

Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complications despite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, we reviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile; 2. feasibility for assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 arm adduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Resting and exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ± 12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg; among those undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Eleven patients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise, ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were found in 7 (78%) and 6 (67%) patients, respectively; the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO >2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12 (3-16) and 16 mmHg (9-28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg with exercise. Conclusions: Diastolic dysfunction and pulmonary hypertension were highly prevalent, with exercise unmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to show significant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish the best diagnostic method for CoA severity assessment.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Assessment Of Coarctation Of the Aorta During Exercisementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

Miguel¹,

Jain²,

Egbe³

et al. 2022

Congenital Heart Disease

View full text Add to dashboard Cite

show abstract

“…Pulse-wave velocity was higher in patients who were hypertensive either on ABPM or during exercise [30]. Egbe et al [31] studied the effect of ventricular and arterial stiffening on exercise response and found that patients with combined ventricular-vascular stiffening had impaired output response and hypertensive response during exercise demonstrating the hemodynamic importance. The utility of exercise testing in management of coarctation patients needs further clinical validation but could be highly relevant to better identify patients at risk for developing long-term complications.…”

Section: Vascular Properties and Ventricular-vascular Interactionsmentioning

confidence: 99%

Challenges in diagnosis and management of coarctation of the aorta

Chetan

Mertens

2021

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of reviewCoarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. Recent findingsRecent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention. New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention.

show abstract

The Relationship of Renal Augmented Velocity Index With Ventricular–Arterial Coupling in Comparison to Renal Resistive Index

Karasu

Emekli

2023

J of Ultrasound Medicine

View full text Add to dashboard Cite

ObjectiveIt's a well‐known scientific statement that the heart and kidney functions are frequently tied together and the impairment of one directly alters the other. However, there exist knowledge gaps about this intricate pathophysiologic link and the exact unifying mechanism is not established. Herein, we aimed to investigate the presence of cardiorenal interaction at subclinical level while the conventional cardiac and renal clinical parameters are not disrupted yet in patients with hypertension.MethodsWe chose a novel renal Doppler ultrasonographic parameter—augmented velocity index (Avi)—and an echocardiographic measure—ventriculoarterial coupling—which is complex to analyze but increasingly used after its acceptance about being a key determinant of cardiovascular efficiency. We recruited 137 patients without a previous history of antihypertensive medication use (47.4% women; median age, 49 years). Renal Avi, renal resistive index (RI), arterial elastance (Ea), ventricular elastance (Ees) and Ea/Ees (ventriculoarterial coupling) parameters were all examined.ResultsRenal Avi, Ea, and Ea/Ees values were higher in females. Correlation analysis revealed that renal Avi was correlated with many hemodynamic variables including Ea and Ea/Ees. On multiple linear regression analysis, Ea and Ea/Ees remained as significant independent predictors of renal Avi but not of renal RI after adjustments for co‐variables (β = 0.488, P < .001 for Ea; β = 0.380, P < .001 for Ea/Ees).ConclusionsIn comparison to renal RI, we suggest that renal Avi is a more reliable and promising index that can even measure subclinical changes in the cardiorenal circulation which needs to be elucidated.

show abstract

Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults With Repaired Coarctation of Aorta

Cited by 3 publications

References 22 publications

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

Challenges in diagnosis and management of coarctation of the aorta

The Relationship of Renal Augmented Velocity Index With Ventricular–Arterial Coupling in Comparison to Renal Resistive Index

Contact Info

Product

Resources

About