Endothelial Dysfunction of Conduit Arteries in Patients with Repaired Coarctation of the Aorta
Endothelial Dysfunction of Conduit Arteries in Patients with Repaired Coarctation of the Aorta
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DOI：
10.1536/ihj.17-564
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发表时间：
2018-11-01
影响因子：
1.5
通讯作者：
Horigome, Hitoshi
中科院分区：
文献类型：
--
作者：
Nozaki, Yoshihiro;Nakayama-Inaba, Kasumi;Horigome, Hitoshi
成人主动脉缩窄修复术(r-CoA)患者表现出较高的晚期高血压患病率，但其确切机制尚不清楚。内皮功能障碍与这一矛盾的高血压有关。17例r-CoA和1例主动脉弓离断(r-CoA)患者(r-CoA组)，年龄22.0+/-6.9岁(5例女性)，进行右臂动脉FMD、右指PAT、血液标记物、动态血压监测、超声心动图、颈动脉超声和臂踝脉搏波速度测量。主动脉弓重建的中位年龄为2.0个月(四分位数范围15天至7.0岁)。R-CoA组有8例(44%)患者合并高血压(5例接受降压药物治疗)。与对照组比较，r-CoA组患者的FMD值显著降低(3.8g/-1.5vs6.6+/-2.5%，P=0.001)，内-中膜厚度显著增加(0.63+/-0.17vs0.47+/-0.09 mm，P=0.001)，左心室重量指数显著升高(91.4g/-24.6vs73.4+/-17.3g/m(2)，P=0.017)。两组患者的难治性充血指数分别为1.86+/-0.43和1.99+/-0.59，差异无统计学意义(P=0.48)。r-CoA患者的血管功能障碍，尤其是内皮功能障碍，在导管动脉比阻力动脉更明显。
Adult patients with repaired coarctation of the aorta (r-CoA) show high prevalence of late hypertension, but the exact mechanisms of this phenomenon are unknown. Endothelial dysfunction has been implicated in this paradoxical hypertension. We evaluated the endothelial function of both conduit and resistance arteries by using flow-mediated dilation (FMD) and digital peripheral artery tonometry (PAT).Seventeen patients with r-CoA and one patient with repaired interrupted aortic arch (r-CoA group) aged 22.0 +/- 6.9 years (5 females) underwent FMD of the right brachial artery, PAT of the right finger, blood marker tests, ambulatory blood pressure monitoring, echocardiography, carotid ultrasonography, and brachio-ankle pulse wave velocity measurement. The median age at aortic arch reconstruction was 2.0 months (interquartile range: 15 days to 7.0 years). Results were compared with 17 age-matched healthy subjects (control group).Eight (44%) patients of the r-CoA group were hypertensive (5 received antihypertensive drugs). Patients in the r-CoA group showed significantly lower FMD (3.8 +/- 1.5 versus 6.6 +/- 2.5%, P < 0.001), larger intima-media thickness (0.63 +/- 0.17 versus 0.47 +/- 0.09 mm, P = 0.001), and higher left ventricular mass index (91.4 +/- 24.6 versus 73.4 +/- 17.3 g/m(2), P = 0.017) than those in the control group. There were no significant differences in PAT (refractory hyperemia index, 1.86 +/- 0.43 versus 1.99 +/- 0.59, P = 0.48) and brachio-ankle pulse wave velocity between the two groups.Vascular dysfunction in r-CoA patients, particularly endothelial dysfunction, tends to occur more significantly in conduit arteries than in resistance arteries.