BACKGROUND Patients with vascular stiffening may display increased arterial afterload that is out of proportion to systolic blood pressure (SBP). Since vascular and endothelial dysfunction develop in patients with coarctation of aorta (COA), we hypothesized that for any SBP, patients with mild COA (COA peak velocity <2 m/s) will have a higher arterial afterload and increased left ventricular mass index (LVMI) compared with controls, and that Doppler-derived arterial load indices would be a better predictor of LVMI compared with SBP alone. METHODS We studied 204 COA patients (age 35±12 y) and 204 matched controls. Doppler-derived arterial afterload was assessed using effective arterial elastance index and total arterial compliance index. RESULTS Despite similar SBP, the mild COA group displayed higher arterial afterload as evidenced by a higher elastance index (3.3±0.9 versus 2.9±0.7 mm Hg/mL·m2; P<0.001) and lower total arterial compliance index (0.8±0.3 versus 1.2±0.5 mL/mm Hg·m2; P<0.001). This was associated with higher LVMI in COA (109±35 versus 93±32, g/m2; P<0.001). Compared with SBP (β=0.24 [95% CI, 0.02-0.45]), elastance index (β=20.2 [95% CI, 15.8-44.1]) and total arterial compliance index (β=-32.5 [95% CI, -43.8 to -123.6]) were better predictors of LVMI. Elastance index (but not SBP) was predictive of longitudinal increases in LVMI (r=0.43, P<0.001). CONCLUSIONS COA patients had higher arterial afterload compared with controls with similar SBP. In comparison to SBP, Doppler-derived arterial load indices correlate more strongly with LV hypertrophy. These data suggest that SBP may underestimate LV afterload in this population. This has important clinical implications since titration of antihypertensive therapy is currently based on SBP.

中文翻译：

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多普勒衍生的动脉负荷指数比主动脉缩窄的收缩压更好地反映左心室后负荷。


背景血管硬化患者可能表现出动脉后负荷增加，与收缩压（SBP）不成比例。由于主动脉缩窄 (COA) 患者会出现血管和内皮功能障碍，我们假设对于任何 SBP，轻度 COA 患者（COA 峰值速度 <2 m/s）将具有较高的动脉后负荷和增加的左心室质量指数（ LVMI）与对照组相比，并且与单独的 SBP 相比，多普勒衍生的动脉负荷指数将是 LVMI 更好的预测指标。方法 我们研究了 204 名 COA 患者（年龄 35±12 岁）和 204 名匹配的对照者。使用有效动脉弹性指数和总动脉顺应性指数评估多普勒衍生的动脉后负荷。结果 尽管 SBP 相似，但轻度 COA 组表现出较高的动脉后负荷，表现为较高的弹性指数（3.3±0.9 与 2.9±0.7 mm Hg/mL·m2；P<0.001）和较低的总动脉顺应性指数（0.8±0.9）。 0.3 与 1.2±0.5 mL/mm Hg·m2；P<0.001)。这与 COA 中较高的 LVMI 相关（109±35 与 93±32，g/m2；P<0.001）。与收缩压（β=0.24 [95% CI, 0.02-0.45]）、弹性指数（β=20.2 [95% CI, 15.8-44.1]）和总动脉顺应性指数（β=-32.5 [95% CI, -]）相比43.8 至 -123.6]) 是 LVMI 更好的预测因子。弹性指数（但不是 SBP）可预测 LVMI 的纵向增加（r=0.43，P<0.001）。结论 与收缩压相似的对照组相比，COA 患者的动脉后负荷较高。与收缩压相比，多普勒衍生的动脉负荷指数与左室肥厚的相关性更强。这些数据表明 SBP 可能低估了该人群的左室后负荷。这具有重要的临床意义，因为抗高血压治疗的滴定目前是基于收缩压。