Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair.
BACKGROUND
The role of exercise testing in the follow up of adults with a coarctation repair is unclear. Exercise induced systolic hypertension has been advocated as an indication for further investigation; however, the value of exercise testing in this role has been questioned, especially in paediatric populations.


OBJECTIVE
To assess the value of resting and exercise blood pressure measurements in a cohort of adults with repaired coarctation.


METHODS
Tertiary referral centre for adult congenital cardiac disease.


METHODS
56 patients (33 male, 23 female) with a previous coarctation repair, and 33 age matched controls.


METHODS
Resting and exercise blood pressures, including arm-leg systolic blood pressure gradients; standard echocardiographic measurements of left ventricular mass, aortic root diameter, and repair site gradient.


RESULTS
The coarctation cohort had higher resting upper limb blood pressures than the controls (systolic: 129.7 v 120.7 mm Hg, p = 0.014; diastolic: 76.8 v 72.2 mm Hg, p = 0.02). Mean resting arm-leg systolic blood pressure gradient was also higher, at 3.6 v -2.2 mm Hg, p = 0.027. However, there were no differences between the peak exercise systolic blood pressures of the two groups. Peak exercise systolic blood pressure did not correlate with resting arm-leg blood pressure gradient (r = 0.24, p = 0.13) or with repair site gradient (r = 0.14, p = 0.39). Resting upper limb systolic blood pressure and resting arm-leg systolic blood pressure gradient were related to repair site gradient (r = 0.33, p = 0.03, and r = 0.47, p = 0.002).


CONCLUSIONS
Measurements of upper limb blood pressure during exercise are of limited value in the assessment of the post-repair coarctation patient. If routine exercise testing is to be advocated in this population it must be for another indication.
Swan
L
L
Adult Congenital Heart Programme, Royal Brompton Hospital, London, UK. lornaswan@yahoo.com
Goyal
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S
Hsia
C
C
Hechter
S
S
Webb
G
G
Gatzoulis
M A
MA
D000328:Adult; D001017:Aortic Coarctation / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology