Elsevier

Atherosclerosis

Volume 182, Issue 1, September 2005, Pages 97-103
Atherosclerosis

Evidence of vascular dysfunction in young patients with successfully repaired coarctation of aorta

https://doi.org/10.1016/j.atherosclerosis.2005.01.030Get rights and content

Abstract

It is well documented that in patients with coarctation of the aorta life expectancy is not normal even after successful coarctation repair (SCR), primarily due to cardiovascular events. We examined endothelial function in the forearm circulation, the mechanical properties and intima/media thickness in carotid and femoral arteries and the inflammatory process in normotensive patients, after coarctation repair. Fifteen patients, 29 ± 2 years old, 12 ± 2.9 years after SCR and 16 age- and sex-matched controls were enrolled in our study. Forearm blood flow was determined by gauge-strain plethysmography. Forearm vasodilatory response to reactive hyperemia was expressed as the %change from baseline to post-reactive hyperemia blood flow. High resolution ultrasound was used for determination of intima/media thickness and elastic properties of carotid and femoral arteries. Serum levels of soluble vascular adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), E-selectin, and interleukines 1b (IL-1b) and 6 (IL-6) were determined by ELISA. Reactive hyperemia was significantly decreased in patients compared to controls (p < 0.01). Patients with SCR had higher intima/media thickness and decreased distensibility in the carotid arteries than controls (p < 0.01 for both). Serum levels of sICAM-1, sSVCAM-1, E-selectin and IL-1b were higher in SCR group than in controls (p < 0.05 for all). Adult patients after SCR have impaired endothelial function in the forearm circulation, increased intima/media thickness, decreased distensibility in the carotid arteries and increased levels of proinflammatory cytokines and adhesion molecules than healthy controls. These results may partly explain the high incidence of coronary artery disease in patients with repaired coarctation of the aorta.

Introduction

Adult patients even after successful coarctation repair (SCR) suffer from relapse of hypertension and their life expectancy is shorter than normal, because of premature coronary and cerebrovascular events [1], [2], [3]. In addition, it has been shown that aortic elastic properties in patients with coarctation of the aorta are reduced before as well as after surgery because remodeling alterations may exist for unknown period of time [4], [5], [6], [7]. These alterations may be the cause of morbidity and mortality that occur during follow up in this category of patients. The post-repair functional and mechanical properties of conduit arteries and the underlying inflammatory process in these patients are not well studied.

In the present study we compared endothelial function in the forearm circulation as well as mechanical properties and intima/media thickness (IMT) in the carotid and femoral arteries, between normotensive patients with SCR and healthy individuals. We also examined whether inflammatory markers such as C-reactive protein (CRP), fibrinogen, interleukins 1b (IL-1b) and 6 (IL-6), and the soluble forms of adhesion molecules such as E-selectin, vascular cell adhesion molecule (sVCAM-1) and intercellular adhesion molecule (sICAM-1), play a role in these patients.

Section snippets

Patients

Sixteen normotensive patients aged 29.9 ± 2.2 years old, 12.2 ± 02.9 years after SCR were randomly selected from out database and 16 age- and sex-matched controls were also recruited. After the initial recruitment one patient refused to participate and she was excluded from the study (Table 1). To avoid any non-specific effects of hypertension on the examined parameters, patients with arterial blood pressure at the right arm <140/90 mmHg were excluded from the study. Furthermore, all patients had

Results

There were no significant differences in demographic characteristics and serum lipid levels between patients and controls. There was no significant difference in systolic blood pressure between patients and controls, although patients had significantly lower diastolic blood pressure and higher pulse pressure (Table 1).

Although forearm blood flow and NTG were not significantly different between the two groups, forearm vasodilatory response to reactive hyperemia was significantly lower in

Discussion

The results of the present study indicate that adult patients after SCR have impaired endothelial function in the forearm circulation, increased intima/media thickness, decreased distensibility in the carotid arteries and increased levels of proinflammatory cytokines and adhesion molecules than healthy controls. These results may partly explain the high incidence of coronary artery disease in patients with repaired coarctation.

Conclusions

Adult patients after SCR have abnormal structural and functional properties of the upper part of their body vasculature, increased levels of proinflammatory cytokines and adhesion molecules. These results provide evidence that the alterations in mechanical properties of carotid arteries as well as the generalized endothelial dysfunction and increased inflammatory process observed in patients with coarctation of the aorta are permanent, many years after surgical repair, and may partly explain

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