Abstract 15555: Increased Atherosclerosis Risk in Adult Post-Coarctectomy Patients
Purpose: Despite successful surgery, cardiovascular mortality and morbidity are increased in adult post-coarctectomy patients (CoA). Although the cause for this increased risk is thought to be multifactorial, an increased burden of atherosclerosis might be a reason. Carotid intima-media thickness (CIMT) is a validated marker for atherosclerosis. Recent studies demonstrate that CIMT in the carotid arteries is increased in CoA compared to healthy controls. The aim of the study was to elucidate the process of arterial wall change over time in CoA patients.
Methods: In 75 CoA patients (45 males, mean age 38.7 years range 24-71 years), mean age at repair 8.3 (range 0-37 years) carotid B-mode ultrasound scans, echocardiography and MRI scans were acquired twice between 2002 and 2009. CIMT of pre-coarctic right and left carotid conduits were determined. CIMT progression rates were compared to the literature. Patients were considered hypertensive with mean daytime systolic blood pressure ≥135 mmHg or diastolic blood pressure ≥85 mmHg on 24h blood pressure monitoring or on anti-hypertensive treatment. Residual aortic gradient was defined as ratio coarctation site/aorta diaphragm<0.7 but >0.5.
Results: A significant increase in CIMT was found during follow up (0.63 ± 0.14 mm vs. 0.70 ± 0.14 mm (P<0.001) e.g. 0.011 mm/year (SE 0.002) compared to 0.009 (SE 0.0003) in the healthy population. At baseline 38 patients (51%) were hypertensive, 39 (52%) patients had an increased LDL cholesterol and 21 adult CoA patients had a residual aortic gradient. Hypertension (ß=0.07, p=0.05), increased LDL cholesterol (ß 0.09, p= 0.01) and a residual aortic gradient (ß=0.09, p=0.013) were independently associated with the CIMT at follow-up.
Discussion: This follow-up study for the first time demonstrates the increased CIMT progression rate in CoA patients as compared to the healthy population. These findings point towards an increased risk for atherosclerosis. CoA patients with hypertension, increased LDL cholesterol levels and a mild residual aortic gradient are at increased risk for future cardiovascular disease. These findings support the need for a thorough assessment and treatment cardiovascular disease, and early intervention in patients with a residual gradient.
- © 2011 by American Heart Association, Inc.