Abstract
Background and aimsAfter aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications. The aim of this study was to measure cardiovascular markers, intima-media thickness (IMT) and plaques in controls and patients with CoA. MethodsSixty-four patients with CoA (66% male, mean age 48 ± 15 years) and controls (54% men, mean age 47 ± 16 years) underwent ultrasound of their arteries. A multiplex platform to analyze circulating blood levels biomarkers reflecting inflammation, tissue remodeling and repair was used. ResultsIn men following CoA repair, a significantly increased carotid bulb IMT was observed in comparison to the control group (1.05 [0.72–1.24] vs. 0.67 [0.59–0.95] mm; p = 0.003). Median common carotid artery (CCA) IMT was increased in men compared to controls (0.82 [0.61–0.97] mm vs. 0.58 [0.53–0.76] mm, p < 0.003) and in women compared to controls (0.83 [0.70–0.92] vs. 0.60 [0.55–0.69], p < 0.004). CoA demonstrated an independent association with IMT in both men and women. Men with CoA were also more likely to have a plaque in their carotid arteries (p = 0.010). In women with CoA, we observed significantly lower levels of stem cell factor (SCF, p = 0.004) while in men with CoA we observed significantly lower levels of matrix metalloproteinase-3 (MMP-3, p = 0.048), tumor necrosis factor receptor 1 (TNF-R1, p = 0.032), tumor necrosis factor receptor superfamily member 10B (TRAIL-R2, p = 0.019) and monocyte chemotactic protein 1 (MCP-1, p = 0.015). ConclusionsThis is the first study to show that despite successful CoA repair, patients have more carotid atherosclerosis than can be explained by changes in tissue remodeling and repair.
Highlights
Even after successful aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications, and coronary artery disease is the most common cause of non-perioperative death [1,2]
Women with CoA had lower levels of apolipoproten A1 (ApoA1) and high density lipo protein (HDL), higher levels of triglycerides and were more frequently on anticoagulation therapy, but otherwise there were no significant differences in the clinical characteristics between the CoA and control groups (Table 1A)
Women with CoA had higher levels of HDL and lower body mass index (BMI) compared to men with CoA but otherwise there were no significant differences in the clinical charac teristics between women and men with CoA
Summary
Even after successful aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications, and coronary artery disease is the most common cause of non-perioperative death [1,2]. It has been hypothesized that increased levels of proinflammatory cytokines and adhesion molecules are asso ciated with vascular remodeling in CoA patients [12]. The aim of this present study was to investigate IMT and plaques after CoA repair and associations with cardiovascular markers that might provide patholog ical clues to the underlying mechanisms involved. Conclusions: This is the first study to show that despite successful CoA repair, patients have more carotid atherosclerosis than can be explained by changes in tissue remodeling and repair
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