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Vanreusel I, Hens W, Van Craenenbroeck E, Van Berendoncks A, Segers VFM. Peripheral Microvascular Dysfunction in Children and Adults with Congenital Heart Disease: A Literature Review. Curr Cardiol Rev 2024; 20:1-14. [PMID: 38409710 DOI: 10.2174/011573403x278440240209064408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/08/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
Although there is a continually growing number of patients with congenital heart disease (CHD) due to medical and surgical advances, these patients still have a poorer prognosis compared to healthy individuals of similar age. In patients with heart failure, microvascular dysfunction (MVD) has recently emerged as a crucial modulator of disease initiation and progression. Because of the substantial pathophysiological overlap between CHD and heart failure induced by other etiologies, MVD could be important in the pathophysiology of CHD as well. MVD is believed to be a systemic disease and may be manifested in several vascular beds. This review will focus on what is currently known about MVD in the peripheral vasculature in CHD. Therefore, a search on the direct assessment of the vasodilatory capacity of the peripheral microcirculation in patients with CHD was conducted in the PubMed database. Since there is little data available and the reported studies are also very heterogeneous, peripheral MVD in CHD is not sufficiently understood to date. Its exact extent and pathophysiological relevance remain to be elucidated in further research.
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Affiliation(s)
- Inne Vanreusel
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium
| | - Wendy Hens
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
- Cardiac Rehabilitation Centre, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT Research Group, University of Antwerp, 2000 Antwerp, Belgium
| | - Emeline Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium
| | - Vincent F M Segers
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium
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Vanreusel I, Segers VF, Van Craenenbroeck E, Van Berendoncks A. Coronary Microvascular Dysfunction in Patients with Congenital Heart Disease. Curr Cardiol Rev 2023; 19:e190123212886. [PMID: 36658708 PMCID: PMC10494268 DOI: 10.2174/1573403x19666230119112634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 01/21/2023] Open
Abstract
Congenital heart diseases represent a wide range of cardiac malformations. Medical and surgical advances have dramatically increased the survival of patients with congenital heart disease, leading to a continuously growing number of children, adolescents, and adults with congenital heart disease. Nevertheless, congenital heart disease patients have a worse prognosis compared to healthy individuals of similar age. There is substantial overlap in the pathophysiology of congenital heart disease and heart failure induced by other etiologies. Among the pathophysiological changes in heart failure, coronary microvascular dysfunction has recently emerged as a crucial modulator of disease initiation and progression. Similarly, coronary microvascular dysfunction could be important in the pathophysiology of congenital heart diseases as well. For this systematic review, studies on maximal vasodilatory capacity in the coronary microvascular bed in patients with congenital heart disease were searched using the PubMed database. To date, coronary microvascular dysfunction in congenital heart disease patients is incompletely understood because studies on this topic are rare and heterogeneous. The prevalence, extent, and pathophysiological relevance of coronary microvascular dysfunction in congenital heart diseases remain to be elucidated. Herein, we discuss what is currently known about coronary microvascular dysfunction in congenital heart disease and future directions.
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Affiliation(s)
- Inne Vanreusel
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Vincent F.M. Segers
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Emeline Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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Martins JD, Zachariah J, Selamet Tierney ES, Truong U, Morris SA, Kutty S, de Ferranti SD, Guarino M, Thomas B, Oliveira D, Marinho A, António M, Gauvreau K, Jalles N, Geva T, Carmo MM, Prakash A. Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE - COARCT Study. J Am Heart Assoc 2019; 8:e011536. [PMID: 30929556 PMCID: PMC6509735 DOI: 10.1161/jaha.118.011536] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/31/2019] [Indexed: 01/04/2023]
Abstract
Background Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure ( BP ) phenotype by office BP , ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 03262753.
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Affiliation(s)
- José D. Martins
- Department of Pediatric CardiologyHospital de Santa MartaCentro Hospitalar de Lisboa CentralLisbonPortugal
| | - Justin Zachariah
- Division of Pediatric CardiologyDepartment of PediatricsTexas Children's Hospital and Baylor College of MedicineHoustonTX
| | - Elif Seda Selamet Tierney
- Division of Pediatric CardiologyDepartment of PediatricsLucile Packard Children's Hospital and Stanford UniversityPalo AltoCA
| | - Uyen Truong
- Division of Pediatric CardiologyChildren's Hospital ColoradoDenverCO
| | - Shaine A. Morris
- Division of Pediatric CardiologyDepartment of PediatricsTexas Children's Hospital and Baylor College of MedicineHoustonTX
| | - Shelby Kutty
- Division of Pediatric CardiologyChildren's Hospital and Medical CenterOmahaNE
- University of Nebraska College of MedicineOmahaNE
| | - Sarah D. de Ferranti
- Department of CardiologyBoston Children's Hospital and Harvard Medical SchoolBostonMA
| | - Maria Guarino
- CEDOC Chronic DiseasesNova Medical SchoolLisbonPortugal
| | - Boban Thomas
- Ressonância Magnética CaselasS.A. LisbonPortugal
| | - Diana Oliveira
- Biomedical Engineering DepartmentInstituto Superior TécnicoLisbonPortugal
| | - António Marinho
- Pediatric Cardiology DepartmentHospital Pediátrico de CoimbraCoimbraPortugal
| | - Marta António
- Department of Pediatric CardiologyHospital de Santa MartaCentro Hospitalar de Lisboa CentralLisbonPortugal
| | - Kimberlee Gauvreau
- Department of CardiologyBoston Children's Hospital and Harvard Medical SchoolBostonMA
| | - Nuno Jalles
- Ressonância Magnética CaselasS.A. LisbonPortugal
| | - Tal Geva
- Department of CardiologyBoston Children's Hospital and Harvard Medical SchoolBostonMA
| | | | - Ashwin Prakash
- Department of CardiologyBoston Children's Hospital and Harvard Medical SchoolBostonMA
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Kowalski R, Lee MGY, Doyle LW, Cheong JLY, Smolich JJ, d'Udekem Y, Mynard JP, Cheung MMH. Reduced Aortic Distensibility is Associated With Higher Aorto-Carotid Wave Transmission and Central Aortic Systolic Pressure in Young Adults After Coarctation Repair. J Am Heart Assoc 2019; 8:e011411. [PMID: 30929595 PMCID: PMC6509708 DOI: 10.1161/jaha.118.011411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/31/2019] [Indexed: 01/09/2023]
Abstract
Background The long-term prognosis of patients with repaired aortic coarctation is characterized by high rates of cardiovascular and cerebrovascular disease related to hypertension, the basis of which remains unclear. To define potential underlying mechanisms, we investigated aortic and carotid arterial biomechanics and wave dynamics, and determinants of aortic systolic blood pressure, in young adults after coarctation repair. Methods and Results Aortic arch and carotid biomechanics, wave intensity and wave power, and central aortic blood pressure, were derived from echocardiography and brachial blood pressure in 43 young adults after coarctation repair and 42 controls. Coarctation subjects had higher brachial and central systolic blood pressure ( P=0.04), while aortic compliance was lower and characteristic impedance (Zc) higher. Although carotid intima-media thickness was higher ( P<0.001), carotid biomechanics were no different. Carotid forward compression wave power was higher and was negatively correlated with aortic compliance ( R2=0.42, P<0.001) and distensibility ( R2=0.37, P=0.001) in coarctation subjects. Aortic wave power and wave reflection indices were no different in control and coarctation patients, but coarctation patients with elevated aortic Zc had greater aorto-carotid transmission of forward compression wave power ( P=0.006). Aortic distensibility was the only independent predictor of central aortic systolic blood pressure on multivariable analysis. Conclusions Young adults following coarctation repair had a less compliant aorta, but no change in carotid biomechanics. Reduced aortic distensibility was related to greater transmission of aortic forward wave energy into the carotid artery and higher central aortic systolic blood pressure. These findings suggest that reduced aortic distensibility may contribute to later cardiovascular and cerebrovascular disease after coarctation repair.
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Affiliation(s)
- Remi Kowalski
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of CardiologyRoyal Children's HospitalParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Melissa G. Y. Lee
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
| | - Lex W. Doyle
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of Newborn ServicesRoyal Women's HospitalParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneAustralia
| | - Jeanie L. Y. Cheong
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of Newborn ServicesRoyal Women's HospitalParkvilleVic.Australia
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneAustralia
| | - Joseph J. Smolich
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Yves d'Udekem
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of Cardiac SurgeryRoyal Children's HospitalParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Jonathan P. Mynard
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneAustralia
| | - Michael M. H. Cheung
- Heart Research GroupMurdoch Children's Research InstituteParkvilleVic.Australia
- Department of CardiologyRoyal Children's HospitalParkvilleVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneAustralia
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Marino P, de Oliveira Lopes G, Pereira Borges J, Carolina Terra Cola M, Arkader Kopiler D, Tibirica E. Evaluation of systemic microvascular reactivity in adults with congenital heart disease. CONGENIT HEART DIS 2018; 13:978-987. [DOI: 10.1111/chd.12660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/15/2018] [Accepted: 07/15/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Pablo Marino
- National Institute of Cardiology; Rio de Janeiro Brazil
- Antônio Pedro University Hospital, Federal Fluminense University; Niteroi Brazil
| | - Gabriella de Oliveira Lopes
- National Institute of Cardiology; Rio de Janeiro Brazil
- Laboratory of Physical Activity and Health Promotion, Department of Collective Sports, Institute of Physical Education and Sports; Rio de Janeiro State University; Rio de Janeiro Brazil
| | - Juliana Pereira Borges
- Laboratory of Physical Activity and Health Promotion, Department of Collective Sports, Institute of Physical Education and Sports; Rio de Janeiro State University; Rio de Janeiro Brazil
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Vigneswaran TV, Sinha MD, Valverde I, Simpson JM, Charakida M. Hypertension in Coarctation of the Aorta: Challenges in Diagnosis in Children. Pediatr Cardiol 2018; 39:1-10. [PMID: 29043396 DOI: 10.1007/s00246-017-1739-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
Evidence indicates that patients with coarctation of the aorta (COA) suffer from increased cardiovascular morbidity and mortality in later life despite successful repair of COA in childhood. Systolic arterial hypertension is common, presenting in up to one-third of patients, and is regarded as the main driver of premature cardiovascular events in this group of patients. In this review, we discuss the prevalence and pathophysiology of hypertension in children following successful COA repair with no residual arch obstruction. The challenges in accurate blood pressure assessment at this early phase are considered and non-invasive measures of central blood pressure are discussed. Although the pathways for investigations in adults are well defined, we highlight the need to address the issues of cardiovascular surveillance in children and describe techniques which can provide complementary information for cardiovascular assessment in this group of patients such that timely treatment can occur.
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Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, SE1 7EH, London, UK
| | - Israel Valverde
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK. .,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
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Radke RM, Diller GP, Duck M, Orwat S, Hartmann D, Thum T, Baumgartner H. Endothelial function in contemporary patients with repaired coarctation of aorta. Heart 2014; 100:1696-701. [DOI: 10.1136/heartjnl-2014-305739] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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