Prevalence and Long-Term Predictors of Left Ventricular Hypertrophy, Late Hypertension, and Hypertensive Response to Exercise After Successful Aortic Coarctation Repair

Abstract

Controversial data exist about the long-term results of aortic coarctation (AC) repair. This study explored the prevalence and predictors of left ventricular (LV) hypertrophy, late hypertension, and hypertensive response to exercise in 48 subjects (age, 15.1±9.7years) currently followed in the authors' tertiary care hospital after successful AC repair. Data on medical history, clinical examination, rest and exercise echocardiography, and ambulatory blood pressure monitoring were collected. The time from AC repair to follow-up evaluation was 12.9±9.2years. The prevalence of LV hypertrophy ranged from 23 to 38%, based on the criteria used to identify LV hypertrophy, and that of concentric geometry was 17%. One sixth of the patients without residual hypertension experienced late-onset hypertension. One fourth of those who remained normotensive without medication showed a hypertensive response to exercise. Age at AC repair was the strongest independent predictor of LV hypertrophy, defined using indexation either for body surface area (odds ratio [OR], 1.03; p=0.0090) or for height(2.7) (OR 1.02; p=0.029), and it was the only predictor of late hypertension (OR 1.06; p=0.0023) and hypertensive response to exercise (OR 1.09; p=0.029). The risk of LV hypertrophy was 25% for repair at the age of 3.4years but rose to 50 and 75% for repair at the ages of 5.9 and 8.4years, respectively. Similar increases were found for the risk of late-onset hypertension and hypertensive response to exercise. A considerable risk of LV hypertrophy, late hypertension, and hypertensive response to exercise exists after successful AC repair. Older age at intervention is the most important predictor of these complications.