Aortic arch shape after arch repair predicts exercise capacity: a multicenter analysis

J. Mandell, Jennifer Romanowicz, Y. Loke, Nobuyuki Ikeda, Pena Emily, Umar Siddiqi, Narutoshi Hibino, Mark E Alexander, Andrew J Powell, Laura J Olivieri
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Abstract

Coarctation of the aorta is associated with long term morbidity including decreased exercise capacity, despite successful repair. In the absence of discrete recoarctation, the hemodynamic mechanism remains unknown. This multicenter study evaluated the relationship between aorta shape, flow, and exercise capacity in patients after arch repair, specifically through the lens of aortic size mismatch and descending aortic (DAo) flow and their association with exercise. Cardiac magnetic resonance (CMR), cardiopulmonary exercise test, and echocardiogram data within 1 year were analyzed from 58 patients (age 28 ± 10 years, 48% male) across 4 centers with history of isolated arch repair. Aortic arch measurements were correlated with % predicted VO2max with sub-group analyses of those with residual arch obstruction, bicuspid aortic valve, and hypertension. Ascending aorta (AAo) to DAo diameter ratio (DAAo/DDAo) was negatively correlated with % predicted VO2max. %DAo flow positively correlated with VO2max. Sub-analyses demonstrated the negative correlation of DAAo/DDAo with VO2max was maintained only in patients without arch obstruction and with a bicuspid aortic valve. Smaller aortic arch measurements were associated with both hypertension and exercise-induced hypertension. Aorta size mismatch, due to AAo dilation or small DAo, and associated decreased %DAo flow, correlated significantly with decreased exercise capacity after aortic arch repair. These correlations were stronger in patients without arch obstruction and with a bicuspid aortic valve. Aorta size mismatch and %DAo flow capture multiple mechanisms of altered hemodynamics beyond blood pressure gradient or discrete obstruction and can inform the definition of a successful repair.
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主动脉弓修补术后主动脉弓形状对运动能力的预测:一项多中心分析
主动脉共动脉尽管能成功修复,但长期发病率包括运动能力下降。在没有离散性再梗塞的情况下,血液动力学机制仍然未知。这项多中心研究评估了主动脉弓修复术后患者主动脉形状、血流和运动能力之间的关系,特别是通过主动脉尺寸不匹配和降主动脉(DAo)血流及其与运动的关系。 研究人员分析了 4 个中心 58 名有孤立足弓修复史的患者(年龄为 28 ± 10 岁,48% 为男性)一年内的心脏磁共振(CMR)、心肺运动测试和超声心动图数据。主动脉弓测量值与预测 VO2max 的百分比相关,并对有残余弓阻塞、主动脉瓣双瓣和高血压的患者进行了分组分析。升主动脉(AAo)与 DAo 直径比(DAAo/DDAo)与预测 VO2max 百分比呈负相关。DAo流量与最大氧饱和度呈正相关。子分析表明,DAAo/DDAo 与 VO2max 的负相关性仅在无主动脉弓阻塞和有主动脉瓣二尖瓣的患者中保持不变。较小的主动脉弓测量值与高血压和运动诱发的高血压有关。 主动脉尺寸不匹配(由于 AAo 扩张或 DAo 较小)以及相关的 DAo 流量百分比下降与主动脉弓修复后运动能力下降有显著相关性。在没有主动脉弓阻塞和主动脉瓣双瓣的患者中,这种相关性更强。除了血压梯度或离散性阻塞外,主动脉大小不匹配和DAo血流百分比还能捕捉到血液动力学改变的多种机制,并能为成功修复的定义提供参考。
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