title: Endothelial function in contemporary patients with repaired coarctation of aorta.
abstract: OBJECTIVE
  Previous studies have suggested endothelial dysfunction in adult patients after repair of aortic coarctation (CoA). It has been proposed to play a key role in the pathogenesis of arterial hypertension in the absence of re-coarctation. We aimed to assess the presence of endothelial dysfunction, the number of endothelial progenitor cells (EPC), and the levels of proinflammatory cytokines associated with endothelial injury in contemporary patients after CoA repair.
  
  
  METHODS
  For this prospective observational study, 20 CoA patients and 22 healthy controls were recruited. Digital reactive hyperaemia was measured by peripheral arterial tonometry. Flow cytometry was used to quantify EPCs, and a comprehensive panel of laboratory markers of endothelial dysfunction was measured.
  
  
  RESULTS
  Half the patients had known arterial hypertension requiring medical treatment. Indices of reactive hyperaemia showed no significant difference between CoA patients (1.96±0.32) and controlss (1.765±0.48) (p=0.82). Circulating EPCs, defined by the number of CD34(+), CD34(+)/KDR(+), CD34(+)/AC133(+), CD34(+)/AC133(+)/KDR(+) or CD34(+)/CD45(-) labelled cells were equally not significantly different between the groups. Furthermore, plasma levels of inflammatory mediators and markers of endothelial function (IL-6, IL-8, ICAM1 and VCAM1) were not significantly different between the groups, as were vascular endothelial growth factor levels (p>0.05, for all).
  
  
  CONCLUSIONS
  By contrast with earlier reports, no clinically significant difference in endothelial function between adult patients with coarctation repair and healthy controls could be demonstrated. Therefore, endothelial dysfunction may not necessarily be present in this population. Further studies are required to identify mechanisms and to develop strategies to avoid arterial hypertension in these patients.
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
authors.forename: R M
authors.initials: RM
authors.lastname: Radke
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
authors.forename: G-P
authors.initials: GP
authors.lastname: Diller
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Duck
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Orwat
authors.affiliation: Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hartmann
authors.affiliation: Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Thum
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000503:physiopathology* / Q000601:surgery; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D015150:Echocardiography, Doppler; D066026:Endothelial Progenitor Cells / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D014664:Vasodilation / Q000502:physiology*
keywords: CONGENITAL HEART DISEASE; HYPERTENSION