TY  - EJOU
AU  - Miguel, Irene Martin de 
AU  - Jain, C. Charles 
AU  - Egbe, Alexander C. 
AU  - Anderson, Jason H. 
AU  - Connolly, Heidi M. 
AU  - Miranda, William R. 

TI  - Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta
T2  - Structural and Congenital Heart Disease

PY  - 2022
VL  - 17
IS  - 6
SN  - 3071-1738

AB  - <b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.
KW  - Coarctation of the aorta; exercise heart catheterization; diastolic dysfunction; hypertension

DO  - 10.32604/chd.2022.023969