Key result
Exercise cardiac catheterization in adults with coarctation of the aorta unmasked abnormal diastolic and pulmonary vascular reserve, but did not significantly increase peak-to-peak CoA gradients (median 12 mmHg at rest vs 16 mmHg during exercise, p=0.4).
Why the study?
Coarctation of the aorta is associated with generalized arteriopathy and long-term complications despite repair, but data on invasive exercise hemodynamics in this population are lacking.
Does exercise catheterization unmask abnormal hemodynamics and assess severity in adults with coarctation of the aorta?
Observational (n=20)
No
Does exercise catheterization unmask abnormal hemodynamics and assess severity in adults with coarctation of the aorta?
Absolute Event Rate: 16% vs 12%
p-value: p=0.4
Exercise catheterization in adults with coarctation of the aorta frequently unmasks diastolic dysfunction and abnormal pulmonary vascular reserve, though it rarely shows significant increases in CoA peak-to-peak gradients.
Exercise catheterization may characterize hemodynamics in repaired CoA; leaves open its role in severity assessment pending larger studies.
Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complications despite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, we reviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile; 2. feasibility for assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 arm adduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Resting and exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ± 12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg; among those undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Eleven patients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise, ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were found in 7 (78%) and 6 (67%) patients, respectively; the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO >2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12 (3–16) and 16 mmHg (9–28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg with exercise. Conclusions: Diastolic dysfunction and pulmonary hypertension were highly prevalent, with exercise unmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to show significant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish the best diagnostic method for CoA severity assessment.
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Miguel et al. (2022) conducted an observational in Coarctation of the Aorta (n=20). Exercise cardiac catheterization vs. Resting hemodynamics was evaluated on Peak-to-peak coarctation of the aorta gradient (p=0.4). Exercise cardiac catheterization in adults with coarctation of the aorta unmasked abnormal diastolic and pulmonary vascular reserve, but did not significantly increase peak-to-peak CoA gradients (median 12 mmHg at rest vs 16 mmHg during exercise, p=0.4).
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