Vascular and Autonomic Function in Preschool-aged Children with Congenital Heart Disease

ABSTRACT Objective. To compare indices of vascular health and heart rate variability in preschool‐aged children with repaired congenital heart disease (CHD) including tetralogy of Fallot (n = 6) and coarctation of the aorta (n = 6). Design. A cross‐sectional study design was used. All measures were noninvasive and collected over a single testing session under the supervision of a parent/guardian. Setting. Data collection took place in a quiet, temperature‐controlled room (23°± 1°C) with the participant in a supine position. Patients. Twelve (six females, six males) preschool‐aged children with repaired CHD (CHD: 4 ± 1 years) and 12 age‐ and gender‐matched healthy controls (CON: 5 ± 1 years) participated in the study. Outcome Measures. Supine, resting measures of heart rate variability (time, frequency, and nonlinear domains), whole‐body pulse wave velocity (ventricular depolarization to dorsalis pedis artery), brachial blood pressures, and carotid artery distensibility, lumen diameter, intima‐media thickness, and wall/lumen ratio were collected in both groups. Results. The groups were similar in age, height, and weight; however, CON had significantly higher body mass index values (CON: 16.9 ± 2.2, CHD: 15.1 ± 1.0, P < .05) and body mass index percentiles (CON: 69 ± 27%tile, CHD: 36 ± 24%tile, P < .01) compared to CHD. No group differences were found for resting brachial blood pressures, whole‐body pulse wave velocity, heart rate variability, and carotid artery distensibility, lumen diameter, and intima‐media thickness (P > .05). Carotid artery pulse pressures (CHD: 38 ± 6 mm Hg, CON: 31 ± 6 mm Hg, P < .05) and wall/lumen ratios (CHD: 0.091 ± 0.007, CON: 0.085 ± 0.006, P < .01) were significantly higher in the CHD group. Conclusions. These results may indicate that preschool‐aged children with repaired CHD display early signs of vascular remodeling, but not autonomic or vascular dysfunction. The effects of larger wall/lumen ratios on cardiovascular disease risk require further investigation.