Predictors and Effects of Persistent Hypertension after Successful Treatment of Coarctation of the Aorta

Abstract

Background: Coarctation of the aorta is a congenital heart disease that sometimes remains clinically silent until adulthood, usually presenting with arterial hypertension. It is well known that after coarctation treatment, many patients remain hypertensive despite successful repair. In this study we approached the predictors and effects of residual hypertension after successful coarctation therapy. Methods: It was a cross sectional observational study involving 50 patients who underwent Coarctation repair/angioplasty in Ain Shams university hospitals. We divided the patients into two groups (hypertensive and normotensive) and we studied their demographic data (e.g., age, gender, age at first repair, follow up period, etc.) to conclude the possible predictors of persistent hypertension in such cases. We also performed full echocardiographic assessment including 3D speckle tracking echocardiography to detect subtle changes in left ventricular systolic functions. Results: Hypertensive patients had significantly higher BMI (29.1 kg/m2) as compared to normotensives (24 kg/m2), p < 0.0001. Age at first CoA intervention was significantly higher in hypertensive patients. Hypertensive patients had significantly lower 3D left ventricular strain measures (Global area strain, global circumferential strain and global longitudinal strain). The incidence of bicuspid aortic valve was significantly higher in the hypertensive group, yet it was not an independent predictor of persistent hypertension. Conclusions: The predictors for residual hypertension post successful CoA repair were late intervention and higher BMI. Bicuspid aortic valve was more common in the hypertensive group. Regarding the effects of such disease domain, treated CoA patients with persistent hypertension tended to have higher LV mass index and lower values of LV deformation.