title: Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair.
abstract: Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (P≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg,P=0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m2,P<0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (P=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Michael A
authors.initials: MA
authors.lastname: Quail
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Rebekah
authors.initials: R
authors.lastname: Short
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Bejal
authors.initials: B
authors.lastname: Pandya
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Steeden
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Abbas
authors.initials: A
authors.lastname: Khushnood
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.affiliation: From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.). v.muthurangu@ucl.ac.uk.
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D011183:Postoperative Complications; D063177:Pulse Wave Analysis; D013997:Time Factors; D014655:Vascular Resistance / Q000502:physiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult
keywords: blood pressure; congenital heart disease; hemodynamics; hypertension; magnetic resonance imaging