Open Access

ARTICLE

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

by Irene Martin de Miguel¹, C. Charles Jain¹, Alexander C. Egbe¹, Jason H. Anderson², Heidi M. Connolly¹, William R. Miranda^1,*

1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
2 Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA

* Corresponding Author: William R. Miranda. Email:

Congenital Heart Disease 2022, 17(6), 605-615. https://doi.org/10.32604/chd.2022.023969

Received 20 May 2022; Accepted 20 June 2022; Issue published 11 October 2022

Abstract

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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