Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation
Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Meth...
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| Veröffentlicht in: | European heart journal 2005-01, Vol.26 (1), p.84-90 |
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| creator | Vriend, Joris W.J. Zwinderman, Aeiko H. de Groot, Eric Kastelein, John J.P. Bouma, Berto J. Mulder, Barbara J.M. |
| description | Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient ≥30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio |
| doi_str_mv | 10.1093/eurheartj/ehi004 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67341427</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1196541931</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-b114cd812275e928e7241acb1565d6c1f26056105a1a419a763e7fb835eaf0493</originalsourceid><addsrcrecordid>eNqFkUFv1DAQhSMEokvhzglZSHAi1I5jJzmiLVBEEUiAVHGxJvak9ZLEYZwU-B_8YLzaqJW4cLI0_t4bP78seyz4S8EbeYILXSHQvDvBK895eSfbCFUUeaNLdTfbcNGoXOv64ih7EOOOc15roe9nR0JpoWpebrI_nwidt7O_RnYN_YIsdGzwvXvBCKN3C_TMYbQ4Oj9eMgg0e8tGIAo_94MuEGv7EBybEh8XQgajS1bRLj0QczDAJTI_sglmj-McGXQzUnKfwNN-2-ppA5CdExTGh9m9DvqIj9bzOPv65vWX7Vl-_vHtu-2r89yWopnzVojSuloURaWwKWqsilKAbVM65bQVXaF5CsoVCEgCqLTEqmtrqRA6XjbyOHt-8J0o_FgwzmbwKWrfw4hhiUZXshRlUSXw6T_gLiw0preZQqiy0bIq_gtxJVWC-AGyFGIk7MxEfgD6bQQ3-07NTafm0GmSPFl9l3ZAdytYS0zAsxVIvw59RzBaH285LaXUSiQuP3A-zvjr5h7o-z5ppczZxTejT99v688fTg2XfwEKn72z</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>215490535</pqid></control><display><type>article</type><title>Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Vriend, Joris W.J. ; Zwinderman, Aeiko H. ; de Groot, Eric ; Kastelein, John J.P. ; Bouma, Berto J. ; Mulder, Barbara J.M.</creator><creatorcontrib>Vriend, Joris W.J. ; Zwinderman, Aeiko H. ; de Groot, Eric ; Kastelein, John J.P. ; Bouma, Berto J. ; Mulder, Barbara J.M.</creatorcontrib><description>Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient ≥30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio <0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 male) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1–52.5 years), mean age at repair 8.1 years (range 0.02–37.3 years), mean arm/leg gradient 2±12 mmHg, and mean common carotid intima--media thickness 0.612±0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P<0.001) and common carotid intima--media thickness (P=0.027). Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima--media thickness. Our data suggest that a threshold for re-intervention of residual aortic narrowing lower than posed in current guidelines may be desirable to improve long-term outcome in these patients. However, further research on such aggressive interventional approaches is needed.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehi004</identifier><identifier>PMID: 15615804</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aorta, Thoracic ; Aortic Coarctation - pathology ; Aortic Coarctation - physiopathology ; Aortic Coarctation - surgery ; Aortic Valve Stenosis - pathology ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - physiology ; Blood Pressure Monitoring, Ambulatory - methods ; Cardiology. Vascular system ; Carotid Artery Diseases - pathology ; Carotid Artery, Common - pathology ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Coarctation ; Diseases of the aorta ; Exercise - physiology ; Female ; Humans ; Hypertension ; Hypertension - etiology ; Intima-media thickness ; Magnetic Resonance Angiography - methods ; Male ; Medical sciences ; Middle Aged ; Regression Analysis ; Restenosis ; Risk factors ; Tunica Intima - pathology</subject><ispartof>European heart journal, 2005-01, Vol.26 (1), p.84-90</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Jan 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-b114cd812275e928e7241acb1565d6c1f26056105a1a419a763e7fb835eaf0493</citedby><cites>FETCH-LOGICAL-c419t-b114cd812275e928e7241acb1565d6c1f26056105a1a419a763e7fb835eaf0493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16333651$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15615804$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vriend, Joris W.J.</creatorcontrib><creatorcontrib>Zwinderman, Aeiko H.</creatorcontrib><creatorcontrib>de Groot, Eric</creatorcontrib><creatorcontrib>Kastelein, John J.P.</creatorcontrib><creatorcontrib>Bouma, Berto J.</creatorcontrib><creatorcontrib>Mulder, Barbara J.M.</creatorcontrib><title>Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient ≥30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio <0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 male) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1–52.5 years), mean age at repair 8.1 years (range 0.02–37.3 years), mean arm/leg gradient 2±12 mmHg, and mean common carotid intima--media thickness 0.612±0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P<0.001) and common carotid intima--media thickness (P=0.027). Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima--media thickness. Our data suggest that a threshold for re-intervention of residual aortic narrowing lower than posed in current guidelines may be desirable to improve long-term outcome in these patients. However, further research on such aggressive interventional approaches is needed.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aorta, Thoracic</subject><subject>Aortic Coarctation - pathology</subject><subject>Aortic Coarctation - physiopathology</subject><subject>Aortic Coarctation - surgery</subject><subject>Aortic Valve Stenosis - pathology</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - physiology</subject><subject>Blood Pressure Monitoring, Ambulatory - methods</subject><subject>Cardiology. Vascular system</subject><subject>Carotid Artery Diseases - pathology</subject><subject>Carotid Artery, Common - pathology</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Coarctation</subject><subject>Diseases of the aorta</subject><subject>Exercise - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - etiology</subject><subject>Intima-media thickness</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Regression Analysis</subject><subject>Restenosis</subject><subject>Risk factors</subject><subject>Tunica Intima - pathology</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFv1DAQhSMEokvhzglZSHAi1I5jJzmiLVBEEUiAVHGxJvak9ZLEYZwU-B_8YLzaqJW4cLI0_t4bP78seyz4S8EbeYILXSHQvDvBK895eSfbCFUUeaNLdTfbcNGoXOv64ih7EOOOc15roe9nR0JpoWpebrI_nwidt7O_RnYN_YIsdGzwvXvBCKN3C_TMYbQ4Oj9eMgg0e8tGIAo_94MuEGv7EBybEh8XQgajS1bRLj0QczDAJTI_sglmj-McGXQzUnKfwNN-2-ppA5CdExTGh9m9DvqIj9bzOPv65vWX7Vl-_vHtu-2r89yWopnzVojSuloURaWwKWqsilKAbVM65bQVXaF5CsoVCEgCqLTEqmtrqRA6XjbyOHt-8J0o_FgwzmbwKWrfw4hhiUZXshRlUSXw6T_gLiw0preZQqiy0bIq_gtxJVWC-AGyFGIk7MxEfgD6bQQ3-07NTafm0GmSPFl9l3ZAdytYS0zAsxVIvw59RzBaH285LaXUSiQuP3A-zvjr5h7o-z5ppczZxTejT99v688fTg2XfwEKn72z</recordid><startdate>200501</startdate><enddate>200501</enddate><creator>Vriend, Joris W.J.</creator><creator>Zwinderman, Aeiko H.</creator><creator>de Groot, Eric</creator><creator>Kastelein, John J.P.</creator><creator>Bouma, Berto J.</creator><creator>Mulder, Barbara J.M.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>200501</creationdate><title>Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation</title><author>Vriend, Joris W.J. ; Zwinderman, Aeiko H. ; de Groot, Eric ; Kastelein, John J.P. ; Bouma, Berto J. ; Mulder, Barbara J.M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-b114cd812275e928e7241acb1565d6c1f26056105a1a419a763e7fb835eaf0493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aorta, Thoracic</topic><topic>Aortic Coarctation - pathology</topic><topic>Aortic Coarctation - physiopathology</topic><topic>Aortic Coarctation - surgery</topic><topic>Aortic Valve Stenosis - pathology</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure - physiology</topic><topic>Blood Pressure Monitoring, Ambulatory - methods</topic><topic>Cardiology. Vascular system</topic><topic>Carotid Artery Diseases - pathology</topic><topic>Carotid Artery, Common - pathology</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Coarctation</topic><topic>Diseases of the aorta</topic><topic>Exercise - physiology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - etiology</topic><topic>Intima-media thickness</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Regression Analysis</topic><topic>Restenosis</topic><topic>Risk factors</topic><topic>Tunica Intima - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vriend, Joris W.J.</creatorcontrib><creatorcontrib>Zwinderman, Aeiko H.</creatorcontrib><creatorcontrib>de Groot, Eric</creatorcontrib><creatorcontrib>Kastelein, John J.P.</creatorcontrib><creatorcontrib>Bouma, Berto J.</creatorcontrib><creatorcontrib>Mulder, Barbara J.M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vriend, Joris W.J.</au><au>Zwinderman, Aeiko H.</au><au>de Groot, Eric</au><au>Kastelein, John J.P.</au><au>Bouma, Berto J.</au><au>Mulder, Barbara J.M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2005-01</date><risdate>2005</risdate><volume>26</volume><issue>1</issue><spage>84</spage><epage>90</epage><pages>84-90</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation. Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient ≥30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio <0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 male) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1–52.5 years), mean age at repair 8.1 years (range 0.02–37.3 years), mean arm/leg gradient 2±12 mmHg, and mean common carotid intima--media thickness 0.612±0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P<0.001) and common carotid intima--media thickness (P=0.027). Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima--media thickness. Our data suggest that a threshold for re-intervention of residual aortic narrowing lower than posed in current guidelines may be desirable to improve long-term outcome in these patients. However, further research on such aggressive interventional approaches is needed.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>15615804</pmid><doi>10.1093/eurheartj/ehi004</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aorta, Thoracic Aortic Coarctation - pathology Aortic Coarctation - physiopathology Aortic Coarctation - surgery Aortic Valve Stenosis - pathology Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - physiology Blood Pressure Monitoring, Ambulatory - methods Cardiology. Vascular system Carotid Artery Diseases - pathology Carotid Artery, Common - pathology Clinical manifestations. Epidemiology. Investigative techniques. Etiology Coarctation Diseases of the aorta Exercise - physiology Female Humans Hypertension Hypertension - etiology Intima-media thickness Magnetic Resonance Angiography - methods Male Medical sciences Middle Aged Regression Analysis Restenosis Risk factors Tunica Intima - pathology |
| title | Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation |
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