1
|
Belhadjer Z, Ladouceur M, Soulat G, Legendre A, Gencer U, Dietenbeck T, Iserin L, Houyel L, Bonnet D, Mousseaux E. Increased aortic pressures and pulsatile afterload components promote concentric left ventricular remodeling in adults with transposition of the great arteries and arterial switch operation. Int J Cardiol 2024; 405:131969. [PMID: 38490269 DOI: 10.1016/j.ijcard.2024.131969] [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: 06/27/2023] [Revised: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Functional abnormalities of the ascending aorta (AA) have been mainly reported in young patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA). OBJECTIVES To compare systolic, diastolic brachial and central blood pressures (bSBP, bDBP, cSBP, cDBP), aortic biomechanical parameters, and left ventricular (LV) afterload criteria in adult ASO patients with healthy controls and to assess their relationships with LV remodeling and aortic size. MATERIALS AND METHODS Forty-one prospectively enrolled patients (16.8 to 35.8 years) and 41 age- and sex-matched healthy volunteers underwent cardiac MRI to assess LV remodeling with simultaneous brachial BP estimation. After MRI, carotid-femoral tonometry was performed to measure pulse wave velocity (cfPWV), cSBP and cDBP for further calculation of pulse pressure (cPP), AA distensibility (AAD), and AA and LV elastance (AAE, LVE). RESULTS bSBP, bDBP, cSBP,cDBP and cPP were all significantly higher in ASO group than in controls: cSBP (116.5 ± 13.8 vs 106.1 ± 12.0, p < 0.001), cDBP (72.5 ± 6.9 vs 67.1 ± 9.4, p = 0.002), cPP (44.0 ± 12.1 vs 39.1 ± 8.9, p = 0.003) and not related to aortic size. AAD were decreased in ASO patients vs controls (4.70 ± 2.72 vs 6.69 ± 2.16, p < 0.001). LV mass was correlated with bSBP, cSBP, cPP (ρ = 0.48; p < 0.001), while concentric LV remodeling was correlated with AAE (ρ = 0.60, p < 0.001) and LVE (ρ = 0.32, p = 0.04), but not with distensibility. CONCLUSION Even without reaching arterial hypertension, aortic sBP and PP are increased in the adult TGA population after ASO, altering the pulsatile components of afterload and contributing to LV concentric remodeling.
Collapse
Affiliation(s)
- Zahra Belhadjer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Magalie Ladouceur
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Gilles Soulat
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Antoine Legendre
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Umit Gencer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Thomas Dietenbeck
- SorbonneUniversite, CNRS, INSERM, Laboratoire d'Imagerie Biomedicale, LIB, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Lucile Houyel
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Damien Bonnet
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France
| | - Elie Mousseaux
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France.
| |
Collapse
|