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Determine prevalence of hypertensive response to exercise (HRE) and its association with cardiovascular adverse events (CAE) in patients (pt) with repaired coarctation of aorta (rCOA).
Retrospective review of adult pt with rCOA who had cardiopulmonary exercise tests (CPET) at Mayo Clinic, 1994-2014. Pt with residual COA, defined as aortic isthmus peak velocity >2.5 m/s, were excluded. HRE was defined as peak systolic blood pressure (BP) >200 mm Hg; CAE were defined as cardiovascular death, stroke, acute coronary syndrome, heart failure hospitalization, and left ventricular ejection fraction <35%.
183 pt (82 men [59%]) underwent 213 CPET, with follow-up of 85±13 months. Age at initial COA repair was 9±3 years; age at initial CPET was 40±13 years. HRE occurred in 26 (19%) pt, and 24 (92%) of the pt with HRE had normal resting BP. There were no differences in age, BP at rest, and CPET findings between pt with HRE and those with normotensive response to exercise. There were 28 CAE in 24 pt (17%), and HRE was an independent risk factor for CAE (hazard ratio, 1.46 [1.13-2.52]; P=.04).
HRE can occur even in the setting of normal BP at rest, and it is a risk factor for CAE. We speculate that pt with HRE represent a high-risk group who, presumably, have advanced occult vascular dysfunction. CPET can identify these pt. Further studies are required to determine whether intensive anti-hypertension therapy for this high-risk group will improve outcomes.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: All Things Aortic!
Abstract Category: 09. Congenital Heart Disease: Adult
Presentation Number: 1123-359
- 2018 American College of Cardiology Foundation