1
|
Azarnoosh J, Ghorbannia A, Ibrahim ESH, Jurkiewicz H, Kalvin L, LaDisa JF. Temporal evolution of mechanical stimuli from vascular remodeling in response to the severity and duration of aortic coarctation in a preclinical model. Sci Rep 2023; 13:8352. [PMID: 37221191 PMCID: PMC10205817 DOI: 10.1038/s41598-023-34400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Coarctation of the aorta (CoA) is one of the most common congenital cardiovascular diseases. CoA patients frequently undergo surgical repair, but hypertension (HTN) is still common. The current treatment guideline has revealed irreversible changes in structure and function, yet revised severity guidelines have not been proposed. Our objective was to quantify temporal alterations in mechanical stimuli and changes in arterial geometry in response to the range of CoA severities and durations (i.e. age of treatment) seen clinically. Rabbits were exposed to CoA resulting in peak-to-peak blood pressure gradient (BPGpp) severities of ≤ 10, 10-20, and ≥ 20 mmHg for a duration of ~ 1, 3, or 20 weeks using permanent, dissolvable, and rapidly dissolvable sutures. Elastic moduli and thickness were estimated from imaging and longitudinal fluid-structure interaction (FSI) simulations were conducted at different ages using geometries and boundary conditions from experimentally measured data. Mechanical stimuli were characterized including blood flow velocity patterns, wall tension, and radial strain. Experimental results show vascular alternations including thickening and stiffening proximal to the coarctation with increasing severity and/or duration of CoA. FSI simulations indicate wall tension in the proximal region increases markedly with coarctation severity. Importantly, even mild CoA induced stimuli for remodeling that exceeds values seen in adulthood if not treated early and using a BPGpp lower than the current clinical threshold. The findings are aligned with observations from other species and provide some guidance for the values of mechanical stimuli that could be used to predict the likelihood of HTN in human patients with CoA.
Collapse
Affiliation(s)
- Jamasp Azarnoosh
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Arash Ghorbannia
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - El-Sayed H Ibrahim
- Departments of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hilda Jurkiewicz
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lindsey Kalvin
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John F LaDisa
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
2
|
Ylinen MK, Pihkala JI, Salminen JT, Sarkola T. Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children—a population-based study. Interact Cardiovasc Thorac Surg 2022; 35:6659103. [PMID: 35944231 PMCID: PMC9380783 DOI: 10.1093/icvts/ivac212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to assess predictors of BP and hypertension and relations between BP and LV mass in a population-based retrospective study of repaired isolated coarctation of aorta.
METHODS
We collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000–2012. Systolic hypertension was defined as systolic BP (SBP) z-score ≥+2 standard deviation (SD) or regular use of BP medication. LV hypertrophy was defined as LV mass z-score ≥+2 SD or LV mass index g/m2.7 ≥95th percentile.
RESULTS
The median (25–75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9–13.2) and 11.8 years (7.9–16.0), respectively. Age at first procedure (P = 0.011) and systolic arm-leg-gradient (P = 0.007) were positively and transverse arch (P = 0.007) and isthmus diameter (P = 0.001) z-scores at follow-up were negatively associated with SBP z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; P < 0.001) and arm-leg-gradient at follow-up (mean ± SD, −0.3 ± 14.6 vs −6.4 ± 11.6 mmHg; P = 0.047) adjusted for reintervention for coarctation and age at follow-up. LV hypertrophy was present in 20/227 (9.3%) and related with SBP z-score.
CONCLUSIONS
Higher SBP and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with SBP.
Collapse
Affiliation(s)
- Mari K Ylinen
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Jaana I Pihkala
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Jukka T Salminen
- Department of Pediatric Surgery, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Taisto Sarkola
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
- Minerva Foundation Institute for Medical Research , Helsinki, Finland
| |
Collapse
|
3
|
Remmele J, Willinger L, Oberhofer-Fritz R, Ewert P, Müller J. Increased carotid intima-media thickness and reduced health-related physical fitness in children and adolescents with coarctation of the aorta. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|