Aortic arch shape is not associated with hypertensive response to exercise in patients with repaired congenital heart di
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RESEARCH
Open Access
Aortic arch shape is not associated with hypertensive response to exercise in patients with repaired congenital heart diseases Hopewell N Ntsinjana1, Giovanni Biglino1, Claudio Capelli1, Oliver Tann1, Alessandro Giardini1, Graham Derrick1, Silvia Schievano1 and Andrew M Taylor1,2*
Abstract Background: Aortic arch geometry is linked to abnormal blood pressure (BP) response to maximum exercise. This study aims to quantitatively assess whether aortic arch geometry plays a role in blood pressure (BP) response to exercise. Methods: 60 age- and BSA-matched subjects – 20 post-aortic coarctation (CoA) repair, 20 transposition of great arteries post arterial switch operation (ASO) and 20 healthy controls – had a three-dimensional (3D), whole heart magnetic resonance angiography (MRA) at 1.5 Tesla, 3D geometric reconstructions created from the MRA. All subjects underwent cardiopulmonary exercise test on the same day as MRA using an ergometer cycle with manual BP measurements. Geometric analysis and their correlation with BP at peak exercise were assessed. Results: Arch curvature was similarly acute in both the post-CoA and ASO cases [0.05 ± 0.01 vs. 0.05 ± 0.01 (1/mm/m2); p = 1.0] and significantly different to that of normal healthy controls [0.05 ± 0.01 vs. 0.03 ± 0.01 (1/mm/m2), p < 0.001]. Indexed transverse arch cross sectional area were significantly abnormal in the post-CoA cases compared to the ASO cases (117.8 ± 47.7 vs. 221.3 ± 44.6; p < 0.001) and controls (117.8 ± 47.7 vs. 157.5 ± 27.2 mm2; p = 0.003). BP response to peak exercise did not correlate with arch curvature (r = 0.203, p = 0.120), but showed inverse correlation with indexed minimum cross sectional area of transverse arch and isthmus (r = −0.364, p = 0.004), and ratios of minimum arch area/ descending diameter (r = −0.491, p < 0.001). Conclusion: Transverse arch and isthmus hypoplasia, rather than acute arch angulation plays a role in the pathophysiology of BP response to peak exercise following CoA repair. Keywords: Coarctation, Arterial switch operation, Anatomical models, Blood pressure, Exercise test
Background Both exercise induced and resting arterial hypertension following a successful repair of the coarctation of the aorta (CoA) are well-recognised complications [1-4]. In the general population, exercise induced hypertension has been linked to an increased risk of developing systemic hypertension during early adulthood [5,6]. It has been suggested that as part of post surgical follow-up of CoA patients, exercise testing would help with the identification of re* Correspondence: [email protected] 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Trust, London, UK 2 Cardiorespiratory Unit, Level 7, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
coarctation and of abnormal blood pressure (BP) response [7]. Amongst other suggested aetiologies for residual hypertension [8] is
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