Abstract 12225: Renovascular Interaction in Children With Congenital Heart Disease
Background: Increased arterial stiffness can cause renal dysfunction via microvascular damage, consequently contributing to impaired arterial function by several mechanisms including elevation of blood pressure, abnormal glucose/lipid metabolism, inflammation, oxidative stress, and activation of the renin-angiotensin system. Close association between renal dysfunction and increased arterial stiffness has clearly been demonstrated in adults. We hypothesized that renovascular interactions also exist in children with congenital heart disease (CHD).
Methods and Results: During cardiac catheterization, pulse wave velocity (PWV), a marker of arterial stiffness, was measured during catheter withdrawal from the ascending aorta to the femoral artery in 150 children (3.7 ± 2.3 years) with a variety of CHDs. The relationship between PWV and estimated glomerular filtration rate (eGFR: 112 ± 27, 38-180 ml/min/1.73 m2), derived from the approximation for children, was then investigated. The PWV of the proximal aorta and distal aorta were 619 ± 277 and 444 ± 144 (cm/sec), respectively. The PWV in the proximal aorta, but not that in the distal aorta, significantly correlated with eGFR (PWV = 920-2.48*eGFR, p ≤ 0.05). Multivariate linear regression analysis demonstrated that eGFR was an independent determinant of PWV in the proximal aorta (p = 0.021) even after controlling for confounding factors such as age, sex, blood pressure, and disease type. Moreover, eGFR and PWV were significantly associated with serum levels of fibrogenesis markers aldosterone and amino-terminal procollagen type 3 peptide (p= 0.008, 0.012, respectively).
Conclusions: To the best of our knowledge, this study is the first to demonstrate the presence of renovascular interaction in children with CHD, wherein tissue fibrosis may play a key role. Because both increased arterial stiffness and chronic kidney disease have been identified as independent risk factors for cardiovascular morbidity and mortality, these results suggest the importance of meticulous follow-up of renovascular function and interaction in children with CHD. Studies for the effects of renovascular protective treatments and/or anti-fibrogenesis treatments on the outcome of this population are also warranted.
- © 2013 by American Heart Association, Inc.