Impact of treatment modality on vascular function in coarctation of the aorta

The LOVE-COARCT study

LOVE-COARCT Study

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background-Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results-In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (BP) phenotype by office BP, ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions-In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT03262753.

Original languageEnglish (US)
Article numbere011536
JournalJournal of the American Heart Association
Volume8
Issue number7
DOIs
StatePublished - Jan 1 2019

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Aortic Coarctation
Blood Vessels
Dilatation
Blood Pressure
Vascular Stiffness
Therapeutics
Stents
Magnetic Resonance Spectroscopy
Biomarkers
Exercise
Ambulatory Blood Pressure Monitoring
Metabolome
Manometry
Left Ventricular Function
Extracellular Matrix
Pulse
Aorta
Clinical Trials
Hypertension
Inflammation

Keywords

  • Arterial stiffness
  • Coarctation of the aorta
  • Long-term outcome
  • Pulse wave velocity
  • Vascular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of treatment modality on vascular function in coarctation of the aorta : The LOVE-COARCT study. / LOVE-COARCT Study.

In: Journal of the American Heart Association, Vol. 8, No. 7, e011536, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background-Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results-In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (BP) phenotype by office BP, ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions-In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT03262753.",
keywords = "Arterial stiffness, Coarctation of the aorta, Long-term outcome, Pulse wave velocity, Vascular function",
author = "{LOVE-COARCT Study} and Martins, {Jos{\'e} D.} and Justin Zachariah and Tierney, {Elif Seda Selamet} and Uyen Truong and Morris, {Shaine A.} and Shelby Kutty and {de Ferranti}, {Sarah D.} and Shelby Kutty and Boban Thomas and Diana Oliveira and Ant{\'o}nio Marinho and Marta Ant{\'o}nio and Kimberlee Gauvreau and Nuno Jalles and Tal Geva and Carmo, {Miguel M.} and Ashwin Prakash",
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T2 - The LOVE-COARCT study

AU - LOVE-COARCT Study

AU - Martins, José D.

AU - Zachariah, Justin

AU - Tierney, Elif Seda Selamet

AU - Truong, Uyen

AU - Morris, Shaine A.

AU - Kutty, Shelby

AU - de Ferranti, Sarah D.

AU - Kutty, Shelby

AU - Thomas, Boban

AU - Oliveira, Diana

AU - Marinho, António

AU - António, Marta

AU - Gauvreau, Kimberlee

AU - Jalles, Nuno

AU - Geva, Tal

AU - Carmo, Miguel M.

AU - Prakash, Ashwin

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N2 - Background-Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results-In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (BP) phenotype by office BP, ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions-In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT03262753.

AB - Background-Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results-In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (BP) phenotype by office BP, ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions-In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT03262753.

KW - Arterial stiffness

KW - Coarctation of the aorta

KW - Long-term outcome

KW - Pulse wave velocity

KW - Vascular function

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