Vascular Health in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Abstract

Congenital heart disease (CHD) affects 1% of live births and is a risk factors for cardiovascular disease and reduced life expectancy. Previous studies have suggested CHD is associated with impaired vascular health, but this has not been established. Therefore, the objective of this study was to examine the impact of congenital heart disease (CHD) on vascular health. Eight electronic databases were searched through April 12, 2024. Studies of all designs (except case studies and reviews) which reported on the population (individuals with CHD of any age), comparator (individuals without CHD), and outcomes of interest: endothelial dependent (flow-mediated vasodilation [FMD%], reactive hyperemia index [RHI]) and independent (nitroglycerine mediated dilation [NMD%]) vascular function, arterial stiffness (pulse-wave velocity [PWV], stiffness index [SI], augmentation index [AIx], distensibility and compliance), and carotid intima-media thickness (cIMT) were included. Results are presented as standardized mean differences and 95% confidence intervals and by effect size. 138 studies (N=16,115) were included in the meta-analysis. Individuals with CHD exhibited decreased vascular function compared to those without including decreased FMD% -0.96, 95% CI: -1.22, -0.70, I2= 85%, large effect size), RHI by ultrasound -2.88, 95% CI: -4.85, -0.90, I2 =96%, large effect size), and NMD% -0.98; 95% CI: -1.35, -0.61, I2= 87%, large effect size). Various CHD subtypes including, coarctation of the aorta, transposition of the great arteries, tetralogy of Fallot, post-Fontan showed significant vascular dysfunction. Shunt lesions did not show significant vascular dysfunction. CHD is associated with vascular dysfunction, increased arterial stiffness and greater cIMT in both pediatric and adult patients. PROSPERO registration number: CRD42022369180.