The role of increased preoperative ventricular-arterial stiffening in the hypertension of infants with coarctation of the aorta_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MU Hongwei ,  ZHU Zhongqun

Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200120, P.R.China;

Corresponding author：

ZHU Zhongqun, Email: zzqheart@aliyun.com

Keywords：

Coarctation of the aorta; hypertension; ventricular-arterial stiffening

DOI：

10.7507/1007-4848.202001025

Video：

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Objective To explore the role of increased preoperative ventricular-arterial stiffening in hypertensive infants with coarctation of the aorta (CoA).Methods A retrospective study was conducted in 314 infants with CoA (CoA group, 193 males and 121 females, aged 5.4±2.2 months), and 314 infants receiving tumor chemotherapy with normal cardiovascular function and without pneumonia (control group, 189 males and 125 females, aged 4.4±3.8 months), who were admitted to our hospital from 2015 to 2017. The clinical data of the two groups were compared.Results There were statistical differences in effective aortic elastance index (Eai), effective left ventricular end-systolic elasticity index (Eesi), ventricle-artery coupling index (VACi), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and ratios of left ventricular hypertrophy, dilation and systolic dysfunction between the two groups (P<0.05). Compared with non-hypertensive CoA infants, CoA infants with hypertension had higher Eai, Eesi, NT-ProBNP level and proportion of left ventricular hypertrophy (P<0.05). Compared with concomitant ventricular septal defect, infants with isolated CoA had higher Eai, Eesi, NT-proBNP level, incidence of hypertension and higher proportion of left ventricular hypertrophy, dilation and systolic dysfunction (P<0.05). Eai and Eesi were positively correlated with NT-proBNP level, left ventricular hypertrophy and fractional shortening of left ventricle (P<0.05), while Eai and Eesi were negatively correlated with left ventricular end diastolic volume index, left ventricular end systolic volume index and concomitant ventricular septal defect (P<0.05). Hypertension was related to preoperative left ventricular hypertrophy, Eai, Eesi and NT-ProBNP. Eai was an independent risk factor for hypertension.Conclusion Preoperative ventricular-arterial stiffening is increased in infants with aortic coarctation, which is related to the occurrence of hypertension. Isolated CoA shows more significant increase in ventricular-arterial stiffening, higher ventricular overload and incidence of hypertension.

Citation： MU Hongwei, ZHU Zhongqun. The role of increased preoperative ventricular-arterial stiffening in the hypertension of infants with coarctation of the aorta. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1307-1313. doi: 10.7507/1007-4848.202001025 Copy

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2.	Vigneswaran TV, Sinha MD, Valverde I, et al. Hypertension in coarctation of the aorta: Challenges in diagnosis in children. Pediatr Cardiol, 2018, 39(1): 1-10.
3.	Foulds HJA, Giacomantonio NB, Bredin SSD, et al. A systematic review and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation. J Hum Hypertens, 2017, 31(12): 768-775.
4.	穆宏伟, 祝忠群. 主动脉缩窄术后远期高血压的研究进展. 国际心血管病杂志, 2019, 46(1): 4-7.
5.	Senzaki H, Iwamoto Y, Ishido H, et al. Ventricular-vascular stiffening in patients with repaired coarctation of aorta: integrated pathophysiology of hypertension. Circulation, 2008, 118(14 Suppl): S191-S198.
6.	Dionne JM. Updated guideline may improve the recognition and diagnosis of hypertension in children and adolescents: Review of the 2017 AAP blood pressure clinical practice guideline. Curr Hypertens Rep, 2017, 19(10): 84.
7.	Langley SM, Sunstrom RE, Reed RD, et al. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2013, 16(1): 43-51.
8.	Chen CH, Fetics B, Nevo E, et al. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol, 2001, 38(7): 2028-2034.
9.	Sanz J, García-Alvarez A, Fernández-Friera L, et al. Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study. Heart, 2012, 98(3): 238-243.
10.	Chrysant SG. The clinical significance of N-terminal pro-brain natriuretic peptide in detecting the residual cardiovascular risk in hypertension and other clinical conditions and in predicting future cardiovascular events. J Clin Hypertens (Greenwich), 2016, 18(8): 718-720.
11.	Quail MA, Short R, Pandya B, et al. Abnormal wave reflections and left ventricular hypertrophy late after coarctation of the aorta repair. Hypertension, 2017, 69(3): 501-509.
12.	Yokoyama U, Ichikawa Y, Minamisawa S, et al. Pathology and molecular mechanisms of coarctation of the aorta and its association with the ductus arteriosus. J Physiol Sci, 2017, 67(2): 259-270.
13.	Lombardi KC, Northrup V, McNamara RL, et al. Aortic stiffness and left ventricular diastolic function in children following early repair of aortic coarctation. Am J Cardiol, 2013, 112(11): 1828-1833.
14.	Brili S, Antonopoulos AS, Oikonomou E, et al. Impairment of arterial elastic properties and elevated circulating levels of transforming growth factor-beta in subjects with repaired coarctation of aorta. Int J Cardiol, 2016, 207: 282-283.
15.	Shang Q, Sarikouch S, Patel S, et al. Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain. Eur Radiol, 2017, 27(1): 167-177.
16.	Kim GB, Kang SJ, Bae EJ, et al. Elastic properties of the ascending aorta in young children after successful coarctoplasty in infancy. Int J Cardiol, 2004, 97(3): 471-477.
17.	Liu J, Drak D, Krishnan A, et al. Left ventricular fibrosis and systolic hypertension persist in a repaired aortic coarctation model. Ann Thorac Surg, 2017, 104(3): 942-949.
18.	Hager A, Kanz S, Kaemmerer H, et al. Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation. Am J Cardiol, 2008, 101(12): 1777-1780.
19.	Nir A, Nasser N. Clinical value of NT-ProBNP and BNP in pediatric cardiology. J Card Fail, 2005, 11(5 Suppl): S76-S80.
20.	Wieshammer S, Dreyhaupt J, Basler B, et al. NT-proBNP for pulmonologists: not only a rule-out test for systolic heart failure but also a global marker of heart disease. Respiration, 2009, 77(4): 370-380.
21.	Popelová J, Kotaška K, Černý S, et al. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol, 2012, 28(4): 471-476.

1. O'Sullivan J. Late hypertension in patients with repaired aortic coarctation. Curr Hypertens Rep, 2014, 16(3): 421.
2. Vigneswaran TV, Sinha MD, Valverde I, et al. Hypertension in coarctation of the aorta: Challenges in diagnosis in children. Pediatr Cardiol, 2018, 39(1): 1-10.
3. Foulds HJA, Giacomantonio NB, Bredin SSD, et al. A systematic review and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation. J Hum Hypertens, 2017, 31(12): 768-775.
4. 穆宏伟, 祝忠群. 主动脉缩窄术后远期高血压的研究进展. 国际心血管病杂志, 2019, 46(1): 4-7.
5. Senzaki H, Iwamoto Y, Ishido H, et al. Ventricular-vascular stiffening in patients with repaired coarctation of aorta: integrated pathophysiology of hypertension. Circulation, 2008, 118(14 Suppl): S191-S198.
6. Dionne JM. Updated guideline may improve the recognition and diagnosis of hypertension in children and adolescents: Review of the 2017 AAP blood pressure clinical practice guideline. Curr Hypertens Rep, 2017, 19(10): 84.
7. Langley SM, Sunstrom RE, Reed RD, et al. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2013, 16(1): 43-51.
8. Chen CH, Fetics B, Nevo E, et al. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol, 2001, 38(7): 2028-2034.
9. Sanz J, García-Alvarez A, Fernández-Friera L, et al. Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study. Heart, 2012, 98(3): 238-243.
10. Chrysant SG. The clinical significance of N-terminal pro-brain natriuretic peptide in detecting the residual cardiovascular risk in hypertension and other clinical conditions and in predicting future cardiovascular events. J Clin Hypertens (Greenwich), 2016, 18(8): 718-720.
11. Quail MA, Short R, Pandya B, et al. Abnormal wave reflections and left ventricular hypertrophy late after coarctation of the aorta repair. Hypertension, 2017, 69(3): 501-509.
12. Yokoyama U, Ichikawa Y, Minamisawa S, et al. Pathology and molecular mechanisms of coarctation of the aorta and its association with the ductus arteriosus. J Physiol Sci, 2017, 67(2): 259-270.
13. Lombardi KC, Northrup V, McNamara RL, et al. Aortic stiffness and left ventricular diastolic function in children following early repair of aortic coarctation. Am J Cardiol, 2013, 112(11): 1828-1833.
14. Brili S, Antonopoulos AS, Oikonomou E, et al. Impairment of arterial elastic properties and elevated circulating levels of transforming growth factor-beta in subjects with repaired coarctation of aorta. Int J Cardiol, 2016, 207: 282-283.
15. Shang Q, Sarikouch S, Patel S, et al. Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain. Eur Radiol, 2017, 27(1): 167-177.
16. Kim GB, Kang SJ, Bae EJ, et al. Elastic properties of the ascending aorta in young children after successful coarctoplasty in infancy. Int J Cardiol, 2004, 97(3): 471-477.
17. Liu J, Drak D, Krishnan A, et al. Left ventricular fibrosis and systolic hypertension persist in a repaired aortic coarctation model. Ann Thorac Surg, 2017, 104(3): 942-949.
18. Hager A, Kanz S, Kaemmerer H, et al. Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation. Am J Cardiol, 2008, 101(12): 1777-1780.
19. Nir A, Nasser N. Clinical value of NT-ProBNP and BNP in pediatric cardiology. J Card Fail, 2005, 11(5 Suppl): S76-S80.
20. Wieshammer S, Dreyhaupt J, Basler B, et al. NT-proBNP for pulmonologists: not only a rule-out test for systolic heart failure but also a global marker of heart disease. Respiration, 2009, 77(4): 370-380.
21. Popelová J, Kotaška K, Černý S, et al. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol, 2012, 28(4): 471-476.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The role of increased preoperative ventricular-arterial stiffening in the hypertension of infants with coarctation of the aorta

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