Prevalence of arterial hypertension, hemodynamic phenotypes, and left ventricular hypertrophy in children after coarctat
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ORIGINAL ARTICLE
Prevalence of arterial hypertension, hemodynamic phenotypes, and left ventricular hypertrophy in children after coarctation repair: a multicenter cross-sectional study Skaiste Sendzikaite 1 & Rita Sudikiene 1 & Virgilijus Tarutis 1 & Inguna Lubaua 2 & Pauls Silis 2 & Agata Rybak 3 & Augustina Jankauskiene 1 & Mieczyslaw Litwin 4 Received: 26 March 2020 / Revised: 28 May 2020 / Accepted: 3 June 2020 # IPNA 2020
Abstract Background This study aimed to evaluate hemodynamic phenotypes and prevalence of left ventricular hypertrophy in children after coarctation repair with right arm and leg blood pressure difference < 20 mmHg. Secondary objectives were analysis of effects of age at intervention, residual gradient across the descending aorta, and type of correction. Methods Blood pressure status and left ventricular hypertrophy were diagnosed according to European Society of Hypertension 2016 guidelines. Results Of 90 patients with a median age 12.5 (8.9–15.8) years, 8.5 (6.0–11.8) years after coarctation repair who were included, 42 (46.7%) were hypertensive. Isolated systolic hypertension dominated among 29 hypertensive patients with uncontrolled or masked hypertension (25 of 29; 86.2%). Of the 48 patients with office normotension, 14.6% (7) had masked hypertension, 8.3% (4) had ambulatory prehypertension, and 54.2% (26) were truly normotensive. Left ventricular hypertrophy was diagnosed in 29 patients (32.2%), including 14 of 42 (33.3%) hypertensive and 15 of 48 (31.3%) normotensive patients. The peak systolic gradient across the descending aorta was greater in hypertensive subjects (33.3 ± 12.7 mmHg) compared with normotensive subjects (25 ± 8.2 mmHg, p = 0.0008). Surgical correction was performed earlier than percutaneous intervention (p < 0.0001) and dominated in 40 of 48 (83.3%) normotensive versus 24 of 42 (57.1%) hypertensive patients (p = 0.006). Conclusions Arterial hypertension with isolated systolic hypertension as the dominant phenotype and left ventricular hypertrophy are prevalent even after successful coarctation repair. Coarctation correction from the age of 9 years and older was associated with a higher prevalence of hypertension. Keywords Coarctation of the aorta . Arterial hypertension . Left ventricular hypertrophy . Isolated systolic hypertension . Children
Introduction Coarctation of the aorta is a congenital narrowing of the aortic arch with a disturbed structure in the aortic wall. Coarctation
* Skaiste Sendzikaite [email protected] 1
Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
2
Clinic for Paediatric Cardiology and Cardiac Surgery, Children’s Clinical University Hospital, Stradins University, Riga, Latvia
3
Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
4
Department of Nephrology and Arterial Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
of the aorta accounts for 5–8% of all congenital heart defects and can present at any age [1, 2]. Critical coar
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