Background
Methods
Study population
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Residual isthmic gradient by echo-Doppler less than 20 mm Hg;
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Aortic diameter at the site of repair/diaphragmatic aorta ratio more than 0.7 at cardiac MRI
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No associated cardiac abnormalities or moderate/severe valve heart disease;
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No bicuspid aortic valve with moderate/severe regurgitation or stenosis;
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Absence of history of myocardial infarction or prior myocardial revascularization, asymptomatic known LV dysfunction, heart failure, primary cardiomyopathies or myocarditis, atrial fibrillation, chronic kidney disease, obstructive sleep apnea syndrome, RA (all conditions eliciting changes in LV geometry and LV systolic dysfunction). All patients underwent transthoracic echocardiogram, clinical and laboratory evaluation at the CV Center, Maggiore Hospital, Trieste, Italy. Patients expressed their general written consent to the anonymous use of data for their care and research purposes. The study complies with the Declaration of Helsinki as revised in 2000; the locally appointed ethic committee has approved the research protocol.
Rheumatoid arthritis group
Control group
Definitions
Echocardiography
Calculation of aortic stiffness
Cardiac magnetic resonance
Statistical analysis
Results
Study population
Variables | Aortic coarctation (19 patients) | Controls (38 patients) | RA (38 patients) |
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Clinical | |||
Age (years) | 33 ± 12 | 35 ± 14 | 37 ± 6 |
Female gender (%) | 37 | 32 | 48 |
Body mass index (Kg/m2) | 23.9 ± 4.0 | 26.8 ± 4.4 | 24.2 ± 4.2 |
Obesity (%) | 11 | 17 | 9 |
Hypertension (%) | 58 | 65 | 41 |
Dyslipidemia (%) | 5 | 5 | 15 |
Active smoker (%) | 21 | 12 | 28 |
Diabetes (%) | 5 | 5 | 3 |
Systolic blood pressure (mmHg) | 127 ± 17 | 131 ± 19 | 125 ± 16 |
Diastolic blood pressure (mmHg) | 77 ± 9 | 83 ± 10 | 82 ± 10 |
Heart rate (beats/minute) | 68 ± 12 | 71 ± 14 | 76 ± 10 |
Laboratory | |||
Glycemia (mg/dl) | 93 ± 9 | 98 ± 10 | 93 ± 9 |
Hemoglobin (gr/dl) | 13.8 ± 1.6 | 14.6 ± 1.7 | 14.0 ± 1.2 |
GFR (ml/min/1.73m2) | 105 ± 26 | 103 ± 20 | 108 ± 26 |
Pharmacological treatment | |||
Betablockers (%) | 32 | 22 | 8
# §
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ACEi / ARB (%) | 32 | 52 | 12
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Diuretics (%) | 16 | 30 | 3
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Calcium antagonists (%) | 11 | 35 | 3
# §
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Anti-platelets agents (%) | 0 | 1 | 4 |
Statins (%) | 0 | 1 | 1 |
Variables | Aortic coarctation (19 patients) | Controls (38 patients) | RA (38 patients) |
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LV End-diastolic diameter (ml/m2) | 2.9 ± 0.3 | 2.3 ± 0.4 * | 2.6 ± 0.3
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LV End-systolic diameter (ml/m 2) | 1.9 ± 0.3 | 1.4 ± 0.4 * | 1.7 ± 0.2
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LV End-diastolic volume (ml/m2) | 66 ± 19 | 56 ± 12 | 51 ± 9
# §
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LV End-systolic volume (ml/m2) | 27 ± 9 | 21 ± 6 | 17 ± 4
# §
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Relative wall thickness | 0.35 ± 0.06 | 0.40 ± 0.07 * | 0.43 ± 0.06
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Concentric LV geometry (%) | 11 | 45 * | 51
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LV mass index (g/m 2.7) | 41 ± 14 | 38 ± 13 | 38 ± 7
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LV hypertrophy (%) | 37 | 20 * | 6
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Inappropriate LV mass (%) | 11 | 10 | 36
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LV stroke volume (ml) | 73 ± 25 | 74 ± 18 | 59 ± 15
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Cardiac index (l/min/ m2) | 2.7 ± 0.9 | 2.4 ± 0.7 | 2.3 ± 0.6
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LV ejection fraction (%) | 60 ± 7 | 63 ± 5 | 65 ± 5
#
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LV CESS (dynes/cm2) | 166 ± 49 | 128 ± 48 * | 116 ± 28
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LV Sc- midwall shortening (%) | 101 ± 15 | 98 ± 10 | 85 ± 11 |
Peak S’ (cm/sec) | 7.1 ± 1.3 | 10.5 ± 3.6 * | 10.2 ± 1.6
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Low peak S’ (%) | 84 | 55 * | 27
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Peak E’ (cm/sec) | 10.6 ± 3.5 | 12.3 ± 1.7 | 13.6 ± 2.2 |
E wave of transmitral flow (cm/sec) | 103 ± 16 | 86 ± 19 * | 75 ± 17
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A wave of transmitral flow (cm/sec) | 69 ± 25 | 64 ± 16 | 62 ± 15 |
E / A ratio | 1.4 ± 0.36 | 1.4 ± 0.24 | 1.3 ± 0.40
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E / E’ ratio | 10.5 ± 3.6 | 7.5 ± 2.3 * | 5.6 ± 1.1
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LV diastolic dysfunction (%) | 11 | 2 * | 3
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Maximal left atrial volume (ml/ m2) | 27 ± 11 | 23 ± 11 | 18 ± 4 |
Aortic stiffness index (%) | 9.8 ± 12.6 | 3.1 ± 2.0 * | 4.8 ± 2.5
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Abnormally high aortic stiffness (% of patients) | 26 | 10 | 21 |
Aortic arterial stiffness
Total study population (19 patients) | Abnormally high aortic stiffness NO (14 patients) | Abnormally high aortic stiffness YES (5 patients) |
p
|
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Age (years) | 30 ± 10 | 43 ± 9 | 0.02 |
Body mass index (Kg/m2) | 22.2 ± 2.7 | 27.7 ± 4.5 | 0.004 |
Systolic blood pressure (mmHg) | 120 ± 14 | 144 ± 14 | 0.004 |
Diastolic blood pressure (mmHg) | 73 ± 9 | 83 ± 10 | 0.04 |
E / E’ ratio | 9.5 ± 2.1 | 13.7 ± 5.1 | 0.02 |
LV end-diastolic pressure (mmHg) | 14 ± 3 | 19 ± 6 | 0.02 |
Relative wall thickness | 0.33 ± 0.04 | 0.41 ± 0.04 | 0.002 |
LV mass index (g/m 2.7) | 36 ± 13 | 56 ± 5 | 0.006 |
LV hypertrophy (%) | 15 | 100 | < 0.001 |
Aortic stiffness index (%) | 2.5 ± 1.9 | 28.9 ± 6.5 | < 0.001 |
Standardized coefficients beta |
P
| |
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Left ventricular hypertrophy | 0.62 | < 0.001 |
Left ventricular relative wall thickness | 0.34 | 0.04 |
Final results multivariate regression model Intercept = − 25.0 Standard error of estimation = 6.9 r 2 = 0.74 | 0.86 | < 0.001 |