title: Cardiovascular autonomic dysfunction and carotid stiffness in adults with repaired tetralogy of Fallot.
abstract: OBJECTIVE
  Adults after surgical repair of tetralogy of Fallot (ToF) may have impaired vascular and cardiac autonomic function. Thus, we wanted to assess interrelations between heart rate variability (HRV) and heart rate recovery (HRR), as parameters of cardiac autonomic function, and arterial stiffness, as a parameter of vascular function, in adults with repaired ToF as compared to healthy controls.
  
  
  METHODS
  In a case-control study of adults with repaired ToF and healthy age-matched controls we measured: 5-min HRV variability (with time and frequency domain data collected), carotid artery stiffness (through pulse-wave analysis using echo-tracking ultrasound) and post-exercise HRR (cycle ergometer exercise testing).
  
  
  RESULTS
  Twenty-five patients with repaired ToF (mean age 38 ± 10 years) and 10 healthy controls (mean age 39 ± 8 years) were included. Selected HRR and HRV (time-domain) parameters, but not arterial stiffness were significantly reduced in adults after ToF repair. Moreover, a strong association between late/slow HRR (after 2, 3 and 4 min) and carotid artery stiffness was detected in ToF patients (r = -0.404, p = 0.045; r = -0.545, p = 0.005 and r = -0.545, p = 0.005, respectively), with statistical significance retained even after adjusting for age, gender, resting heart rate and β-blockers use (r = -0.393, p = 0.024 for HRR after 3 min).
  
  
  CONCLUSIONS
  Autonomic cardiac function is impaired in patients with repaired ToF, and independently associated with vascular function in adults after ToF repair, but not in age-matched healthy controls. These results might help in introducing new predictors of cardiovascular morbidity in a growing population of adults after surgical repair of ToF.
authors.affiliation: Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. markonovakovic@rocketmail.com.|Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia. markonovakovic@rocketmail.com.
authors.forename: Marko
authors.initials: M
authors.lastname: Novaković
authors.affiliation: Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.|Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Katja
authors.initials: K
authors.lastname: Prokšelj
authors.affiliation: Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Vito
authors.initials: V
authors.lastname: Starc
authors.affiliation: Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.|Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Jug
mesh_terms: D000328:Adult; D000375:Aging; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D002319:Cardiovascular System / Q000503:physiopathology*; D002339:Carotid Arteries / Q000294:innervation / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012727:Sex Characteristics; D013771:Tetralogy of Fallot / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D059289:Vascular Stiffness
keywords: Autonomic nervous system; Exercise test; Heart rate; Tetralogy of Fallot; Vascular stiffness