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(Circulation. 2008;118:S191-S198.)
© 2008 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Ventricular–Vascular Stiffening in Patients With Repaired Coarctation of Aorta

Integrated Pathophysiology of Hypertension

Hideaki Senzaki, MD; Yoichi Iwamoto, MD; Hirotaka Ishido, MD; Satoshi Masutani, MD; Mio Taketazu, MD; Toshiki Kobayashi, MD; Toshiyuki Katogi, MD; Shunei Kyo, MD

From the Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Medical School Hospital, Saitama, Japan.

Correspondence to Hideaki Senzaki, MD, Staff Office Building 303, Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298 Japan. E-mail hsenzaki{at}saitama-med.ac.jp

Background— Despite successful repair, patients with coarctation of the aorta (COA) often show persistent hypertension at rest and/or during exercise. Previous studies indicated that the hypertension is mainly due to abnormalities in the arterial bed and its regulatory systems. We hypothesized that ventricular systolic stiffness also contributes to the hypertensive state in these patients in addition to increased vascular stiffness.

Methods and Results— The study involved 43 patients with successfully repaired COA and 45 age-matched control subjects. Ventricular systolic stiffness (end systolic elastance) and arterial stiffness (effective arterial elastance) were measured invasively by ventricular pressure–area relationship during varying preload before and after β-adrenergic stimulation. The mean systolic blood pressure was significantly higher with concomitant increases in both end systolic elastance and effective arterial elastance in patients with COA compared with control subjects (113.2±16.8 versus 91.0±9.1 mm Hg, 44.5±17.0 versus 19.2±6.7 mm Hg/mL/m², and 27.8±11.4 versus 20.2±4.8 mm Hg/mL/m², respectively; P<0.01 for each). End systolic elastance and effective arterial elastance of patients with COA showed exaggerated responses to β-adrenergic stimulation, further amplifying blood pressure elevation. Quantification analyses assuming that ventricular systolic stiffness of patients with COA is equal to that of the control revealed that ventricular systolic stiffness accounts for approximately 50% to 70% of the elevated blood pressure in patients with COA. Furthermore, combined ventricular–arterial stiffening amplified systolic pressure sensitivity to increased preload during abdominal compression and limited stroke volume gain/relaxation improvement induced by β-adrenergic stimulation.

Conclusions— Increased ventricular systolic stiffness, coupled with increased arterial stiffness, plays important roles in hypertension in patients with repaired COA. Thus, ventricular systolic stiffness is a potentially suitable target for reduction of blood pressure and improvement of prognosis of patients with COA.

Key Words: blood pressure • congenital • hemodynamics • heart defects • patients