Abstract
Background
With increased long-term survival, children with congenital heart disease (CHD) are
at increased risk of early-onset adult cardiovascular disease. Carotid intima–media
thickness (cIMT) is a surrogate marker of atherosclerosis. The aim of this present
study was to detect high-risk diagnostic subgroups by measuring cIMT and determine
its correlates in children with CHD and subgroups of CHD compared with healthy controls.
Methods
This cross-sectional study enrolled 385 patients (138 girls) aged 5 to 18 years (12.3
± 3.3) who were recruited between May 2015 and June 2017. cIMT was measured using
B-mode ultrasound. Height, weight, body mass index, age, mean arterial pressure, pulse-wave
velocity, and central systolic blood pressure were assessed as possible risk factors.
For subgroup analyses, the patients were divided according to the type of their heart
defects. Furthermore, patient data were compared with 86 healthy controls (35 girls,
12.8 ± 2.5 years) measured in the same time frame with identical ultrasound protocol.
Results
Patients with CHD showed higher cIMT values (cIMT = 0.464 ± 0.039 mm) than healthy
controls (cIMT = 0.449 ± 0.045 mm; P = 0.003), even after adjusting for sex, age, height, and weight differences. The
highest cIMT values were found in children with coarctation of the aorta (cIMT = 0.486
± 0.040 mm; P < 0.001) and transposition of the great arteries after arterial switch (cIMT 0.488
± 0.041 mm; P < 0.001). No correlation was detected between cIMT and mean arterial pressure or
pulse-wave velocity, but with central systolic blood pressure (P = 0.015; r = 0.150).
Conclusions
Children with CHD have increased cIMT compared with healthy controls, particularly
those with coarctation of aorta and transposition of the great arteries.
Résumé
Contexte
Compte tenu de l’allongement de leur survie à long terme, les enfants atteints d’une
cardiopathie congénitale (CC) sont exposés à un risque accru de maladie cardiovasculaire
précoce à l’âge adulte. L’épaisseur intima-média de la carotide (EIMc) est un marqueur
de substitution de l’athérosclérose. L’objectif de la présente étude était d’utiliser
la mesure de l’EIMc pour repérer les sous-groupes de diagnostic à haut risque et déterminer
les corrélats de ce paramètre chez les enfants atteints d’une CC et les sous-groupes
de CC comparativement à des témoins en bonne santé.
Méthodologie
Cette étude transversale portait sur 385 patients (dont 138 filles) âgés de 5 à 18
ans (12,3 ± 3,3), recrutés entre mai 2015 et juin 2017. L’EIMc a été mesurée par échographie
en mode B. La taille, le poids, l’indice de masse corporelle, l’âge, la pression artérielle
moyenne, la vitesse de propagation de l’onde de pouls et la pression artérielle centrale
systolique ont été évalués à titre de facteurs de risque possibles. Pour les analyses
des sous-groupes, les patients ont été regroupés en fonction du type de cardiopathie
dont ils étaient atteints. De plus, les données des patients ont été comparées avec
celles de 86 témoins en bonne santé (dont 35 filles, 12,8 ± 2,5 ans) obtenues durant
la même période et conformément au même protocole d’échographie.
Résultats
Chez les patients atteints d’une CC, l’EIMc était plus élevée (EIMc = 0,464 ± 0,039
mm) que chez les témoins en bonne santé (EIMc = 0,449 ± 0,045 mm; p = 0,003), même après ajustement en fonction du sexe, de l’âge, de la taille et du
poids. Les valeurs maximales de l’EIMc ont été observées dans les cas de coarctation
de l’aorte (EIMc = 0,486 ± 0,040 mm; p < 0,001) et de transposition des gros vaisseaux après détransposition artérielle
(EIMc = 0,488 ± 0,041 mm; p < 0,001). Une corrélation a été observée entre l’EIMc et la pression artérielle centrale
systolique (p = 0,015; r = 0,150), mais pas avec la pression artérielle moyenne ou la vitesse de propagation
de l’onde de pouls.
Conclusions
L’EIMc était plus élevée chez les enfants atteints d’une CC que chez les témoins en
bonne santé, en particulier dans les cas de coarctation de l’aorte et de transposition
des grands vaisseaux.
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Article info
Publication history
Published online: October 05, 2018
Accepted:
September 30,
2018
Received:
March 17,
2018
Footnotes
See page 1622 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
