Abstract
Background
This study aimed to determine the prevalence of hypertensive response to exercise
(HRE) and its association with cardiovascular adverse events (CAEs) in patients with
repaired coarctation of aorta (rCOA).
Methods
We retrospectively reviewed records of adult patients with rCOA who had cardiopulmonary
exercise tests (CPETs) and follow-up from 1994 to 2014 at Mayo Clinic. Patients with
residual COA, defined as aortic isthmus peak velocity >2.5 m/s, were excluded. HRE
was defined as peak systolic blood pressure >200 mm Hg; CAEs were defined as cardiovascular
death, stroke, acute coronary syndrome, heart failure hospitalization, and left ventricular
ejection fraction (LVEF) < 35%.
Results
One hundred thirty-eight patients (82 men [59%]) underwent 213 CPETs, with follow-up
of 85 ± 13 months. Age at initial COA repair was 9 ± 3 years; age at initial CPET
was 40 ± 13 years. HRE occurred in 26 (19%) patients, and 24 (92%) of the patients
with HRE had normal resting blood pressure. There were no differences in age, blood
pressure at rest, and CPET findings between patients with HRE and those with normotensive
response to exercise. There were 28 CAEs in 24 patients (17%), and HRE was an independent
risk factor for CAE (hazard ratio [HR], 1.46 [1.13–2.52]; P = 0.04).
Conclusions
HRE can occur even in the setting of normal blood pressure at rest, and it is a risk
factor for CAE. We speculate that patients with HRE represent a high-risk group of
patients who, presumably, have occult, advanced vascular dysfunction. CPET can identify
these patients. The benefit of intensive antihypertension therapy needs to be confirmed.
Résumé
Contexte
Cette étude visait à déterminer la prévalence de la réponse hypertensive à l’effort
(RHE) ainsi que l’association entre cette réponse et les événements indésirables cardiovasculaires
(EIC) chez des patients ayant subi une réparation d’une coarctation de l’isthme aortique
(rCOA).
Méthodologie
Nous avons effectué un examen rétrospectif des dossiers de patients adultes ayant
subi une rCOA, qui avaient été soumis à des épreuves d’effort cardiopulmonaire (EECP)
et à un suivi entre 1994 et 2014 à la clinique Mayo. Les patients présentant une COA
résiduelle (définie par une vitesse maximale du flux sur l’isthme aortique > 2,5 m/s)
ont été exclus. La RHE était définie par une pression artérielle systolique maximale
> 200 mm Hg; la définition des EIC comprenait les événements suivants : mortalité
cardiovasculaire, AVC, syndrome coronarien aigu, hospitalisation pour insuffisance
cardiaque et fraction d’éjection ventriculaire gauche (FEVG) < 35 %.
Résultats
Un total de 138 patients (82 hommes [59 %]) ont subi 213 EECP, et leur suivi a duré
85 ± 13 mois. L’âge des patients au moment de la réparation initiale de la COA était
de 9 ± 3 ans; au moment des EECP initiaux, leur âge était de 40 ± 13 ans. La RHE est
apparue chez 26 (19 %) patients; 24 (92 %) de ces patients étaient normotendus au
repos. Aucune différence n'a été observée quant à l’âge, à la pression artérielle
au repos et aux résultats des EECP entre les patients présentant une RHE et ceux dont
la réponse hypertensive était normale à l’effort. Il s’est produit 28 EIC chez 24
patients (17 %), et la RHE était un facteur de risque indépendant d’EIC (rapport des
risques instantanés [RRI]: 1,46 [1,13-2,52]; p = 0,04).
Conclusion
La RHE peut apparaître même chez les sujets normotendus au repos, et constitue un
facteur de risque d’EIC. Selon notre hypothèse, les patients obtenant une RHE représentent
un groupe à risque élevé qui, vraisemblablement, sont atteints d’une dysfonction vasculaire
avancée occulte. Les EECP pourraient permettre de reconnaître ces patients. L’avantage
du traitement antihypertensif énergique reste à confirmer.
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Article info
Publication history
Published online: February 07, 2018
Accepted:
February 5,
2018
Received:
December 13,
2017
Footnotes
See page 681 for disclosure information.
See editorial by Millar and Oechslin, pages 536-539 of this issue.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Hypertensive Response With Exercise to Reveal Increased Cardiovascular Risk in Adults With Aortic Coarctation Repair: Value and CautionCanadian Journal of CardiologyVol. 34Issue 5
- PreviewExercise represents a common stress used to perturb the cardiovascular system and uncover physiological differences of clinical relevance not observed at rest.1 On the basis of data from cardiopulmonary exercise testing, it is now widely appreciated that an abnormal heart rate response to exercise (ie, chronotropic incompetence) is predictive of increased all-cause mortality as well as incidence of coronary artery disease.2-4 Less clear has been the clinical value of measuring blood pressure during exercise testing.
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